July 12, 2017

WEEKLY NOTICES OF STATE RULEMAKING
Public Input for Proposed and Adopted Rules

Notices are published each Wednesday to alert the public regarding state agency rulemaking. You may obtain a copy of any rule by notifying the agency contact person. You may also comment on the rule, and/or attend the public hearing. If no hearing is scheduled, you may request one -- the agency may then schedule a hearing, and must do so if 5 or more persons request it. If you are disabled or need special services to attend a hearing, please notify the agency contact person at least 7 days prior to it. Petitions: you can petition an agency to adopt, amend, or repeal any rule; the agency must provide you with petition forms, and must respond to your petition within 60 days. The agency must enter rulemaking if the petition is signed by 150 or more registered voters, and may begin rulemaking if there are fewer. You can also petition the Legislature to review a rule; the Executive Director of the Legislative Council (115 State House Station, Augusta, ME 04333, phone (207) 287-1615) will provide you with the necessary petition forms. The appropriate legislative committee will review a rule upon receipt of a petition from 100 or more registered voters, or from "...any person who may be directly, substantially and adversely affected by the application of a rule..." (Title 5 Section 11112). World-Wide Web: Copies of the weekly notices and the full texts of adopted rule chapters may be found on the internet at: http://www.maine.gov/sos/cec/rules. There is also a list of rulemaking liaisons, who are single points of contact for each agency.

PROPOSALS: no proposals this week


ADOPTIONS

AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS) - Division of Policy
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual (MBM): Ch. II & III Section 93, Opioid Health Home Services
ADOPTED RULE NUMBER: 2017-103
CONCISE SUMMARY: The Department adopts this rule pursuant to PL 2017 Ch. 2 Part P Sec. P-1 (“Establishment of Opioid Health Home Program”). On April 11, 2017, the Department adopted an emergency rule which established the Opioid Health Home Service as a MaineCare service.
This rule makes permanent the April 11, 2017 emergency rule, with some changes. The MaineCare Opioid Health Home (OHH) Services program addresses the opioid crisis in Maine. The OHH initiative is an innovative model providing comprehensive, coordinated care focused on serving the MaineCare population. In addition to providing treatment for an individual’s substance abuse dependency, the OHH integrates physical, social, and emotional supports to provide holistic care. The model provides a community-based support system focused on team-based clinical care. MaineCare members diagnosed with opioid addiction and who have a second chronic condition or are at risk for having a second chronic condition are eligible for these services. The OHH services provide a multi-faceted approach and comprehensive treatment specifically targeted to the opioid dependent population. The program will increase access to treatment options, integrate health and dependency care, and promote stable recovery results. It is expected that this newly established OHH program will not only result in more individuals receiving the substance abuse treatment they need, but will also lead to improvements in the quality of care they are receiving.
The Department has submitted a State Plan Amendment (SPA) request to CMS for approval, and anticipates that CMS will approve the Opioid Health Home SPA. Pending CMS approval, covered services will be provided as described in this rule.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: July 10, 2017
AGENCY CONTACT PERSON: Anne Labonte Perreault, Comprehensive Health Planner, Division of Policy, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207)-624-4082. Fax: (207) 287-1864. TTY users call Maine relay 711. Email: Anne.Labonte-Perreault@Maine.gov .
OMS WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov .

AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS) - Division of Policy
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual (MBM): Ch. X Section 1, Benefit for People Living with HIV/AIDS
ADOPTED RULE NUMBER: 2017-104
CONCISE SUMMARY: The adopted rule changes set out the required co-payments for certain services in a more organized, easier to understand form, and removes the non-applicable 90-day supply co-pay.
Additionally, the rule more specifically-defines actions that may lead to disenrollment, it simplifies disenrollment protocol, and clarifies the appeal rights language.
The rule also updates references in the covered and non-covered services tables to reflect the current MaineCare Benefits Manual policies. For certain additions and removals of services, as noted in each instance in the rule, the Department is seeking and anticipates receiving CMS approval.
This adopted rule updates many outdated references identifying Department agencies, MaineCare Benefits Manual policies and services, outdated internet website addresses, and contains minor grammar and punctuation changes.
EFFECTIVE DATE: July 10, 2017
AGENCY CONTACT PERSON: Anne Labonte Perreault, Comprehensive Health Planner, Division of Policy, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207)-624-4082. Fax: (207) 287-1864. TTY users call Maine relay 711. Email: Anne.Labonte-Perreault@Maine.gov .
OMS WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov .

AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS) - Division of Policy
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual (MBM): Ch. I Section 1, General Administrative Policies and Procedures
ADOPTED RULE NUMBER: 2017-105
CONCISE SUMMARY: This rulemaking adopts the following changes:
1. References to the “Office of Integrated Access and Support” were updated to the “Office for Family Independence.” The name of this agency has changed, and the policy should reflect the name change.
2. Section 1.02-4(B), “Covered Health Care Provider” definition has been expanded to include “a provider of medical or health services and any other person or organization that furnishes, bills, or is paid for health care in the normal course of business” to more accurately mirror federal language.
3. Section 1.02-4(G), added language to the definition of “National Provider Identifier (NPI)” to clarify that the NPI is issued by CMS.
4. Section 1.02-4(H)(3), changed the definition of “Ordering, Prescribing and Referring (OPR) provider” to “Non-Billing, Ordering, Prescribing and Referring Provider (NOPR)” to conform with current online MaineCare billing practices.
5. Section 1.03-1, change of language describing online provider enrollment. In the state of Maine, online enrollment is now the sole means through which providers enroll and update information. Therefore, language was added describing the online enrollment process through the Department’s Health PAS portal. This change is being made to institute the federally mandated revalidation requirements outlined in 42 CFR  424.515.
6. Section 1.03-1(A), addition of language describing the requirement for providers to complete subsequent enrollment applications every three to five years, depending on provider type in order to institute the federally mandated revalidation requirements outlined in 42 CFR  424.515.
7. Section 1.03-1, addition language authorizing the Department to request additional information which demonstrates the provider applicant’s ability to provide high-quality care, services, and supplies, and to be financially responsible. This change is being made to better help ensure MaineCare’s ability to align with federally mandated revalidation requirements in 42 CFR  424.515.
8. Section 1.03-1(C), addition language describing the requirement for providers (with the exception of individual practitioners) to pay an enrollment fee for each provider site. Language was also added describing the option for providers to apply for a fee waiver, as well as the exemption from the fee for providers who have paid an enrollment fee for the site in question during the preceding 12 months to Medicare or another Medicaid agency. This enrollment fee language is being added to comply with 42 CFR  455.460.
9. Section 1.03-B, addition of language stating that providers must obtain a National Provider Identification (NPI) or Atypical Provider Identifier (API) plus three digit service location identifier and use this number in submitting all claims for payment. This change is being made to upgrade the provider enrollment process for efficiency purposes.
10. Section 1.03-2, addition of language stating that out-of-state providers are subject to the same enrollment requirements as in-state providers to ensure all MaineCare providers properly enroll.
11. Section 1.03-3, addition of a list of factors the Department must and may consider in determining whether to enroll or deny enrollment to a provider applicant. Certain situations will trigger automatic denial of enrollment. These changes are being added to conform with 42 CFR  455.410.
12. Section 1.03-3, addition of subsections that set forth the criteria for MaineCare’s denial of provider enrollment or subsequent provider enrollment applications. These changes follow the federal regulations set forth in 42 CFR  455.416.
13. Section 1.03-5, addition of language stating that providers who are terminated from MaineCare (whether involuntarily or voluntarily), have one year from the end date of enrollment to submit claims for services provided during the period of active enrollment. This change was added to be consistent with the one-year regular timely filing noted in Section 1.10-2.
14. Section 1.03-6, addition of language regarding changes of ownership, closures and disenrollment. Providers will be required to notify the Provider Enrollment Unit of any Change in Ownership (CHOW), closure, or intention to disenroll from the MaineCare program no less than thirty (30) days prior to the intended change. Providers undergoing a CHOW will be required to submit a CHOW questionnaire. These changes are being made to conform with federal regulations set forth in 42 CFR  455.104.
15. Section 1.03-7, addition of language stating that the Department will terminate the enrollment of any provider (other than NOPR providers) who has not submitted a claim within 365 days of enrollment. Such providers are eligible to re-enroll at any time. This change is being added to ensure that the MaineCare system has the most current and relevant provider information on record.
16. Section 1.03-8(F), language was updated involving provider nondiscrimination requirements to conform with state and federal laws. The current policy contains an incomplete list of groups whom providers are barred from discriminating against. The Department has added sexual orientation, gender identity, ancestry, age and any other category protected by state and federal law.
17. Section 1.03-8(V), addition of language requiring disclosure of certain ownership or control interests. These requirements follow those of 42 CFR    455.101-105.
18. Section 1.06-2 (A), addition of language stating that the Department will not reimburse for interpreter travel time to help minimize abuse of the interpreter reimbursement.
19. Section 1.06-5, addition of language stating that providers may refuse to continue to see members who have repeatedly broken appointments without prior notice. In such situations, providers must provide advanced notice of office policies concerning no-shows to members before refusing to continue to see those members. This addition is being made to allow providers to refuse to continue to see members only in accordance with the provider’s standard office policies for broken appointments.
20. Section 1.07-1(C), addition of language describing Early and Periodic Screening, Diagnosis and Treatment Services. This additional information provides more detailed and clarifying language regarding the Early and Periodic Screening, Diagnosis and Treatment Services.
21. Section 1.07-3(C), addition of an exception to the requirement that providers appeal third party payer denials of services prior to billing MaineCare. The exception is when Medicare has denied services based on Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs), and also includes Licensed Marriage and Family Therapist (LMFTs), Licensed Professional Counselor (LCPCs), and Licensed Master Social Workers Clinical Conditional (LMSW-CCs) when the following criteria are met: 1) member has an established relationship with the provider; or 2) another provider is not available. This additional language is being added to allow for a more streamlined procedure for allowing for appeals because these provider types are not recognized by Medicare.
22. Section 1.09-2(J), addition of tobacco cessation products and services to the list of copayment exemptions. Copayments for tobacco cessation services are prohibited by 22 MRS  3174-WW.
23. Section 1.11-2, addition of language describing National Correct Coding Initiative (NCCI) edits, and a statement that MaineCare will reject claims not in conformity with NCCI requirements. This change is being made to mirror federal regulations set forth in National Correct Coding Initiative Policy Manual from CMS.
24. Section 1.06-2(I), removal of Private Non-Medical Institutions (PNMIs) from list of facilities that include interpreter services in their reimbursement calculations. Interpreter services are not included in the PNMI rate calculation.
25. Section 1.12-2 (D), addition of language stating that the liability for debts owed to the Department by the provider is enforceable against the provider, including any person who has an ownership or control interest in the provider, and against any officer, director or member of the provider who, in that capacity, is responsible for any control or any management of the funds or finances of the provider. Language has also been added defining “individuals or entities with an ownership or control interest.” These changes are being made to clarify that individuals with management or control over the funds or finances of the provider are personally liable. This addition also corresponds to the language of the MaineCare Provider Agreement, section (D)(3)(c).
26. Section 1.14-1(A), updating of the website address for information regarding prior authorizations.
27. Sections 1.14-2(A)(1) and 1.14-2(B)(3), removal of language allowing for MaineCare covered services to be rendered to members within five miles of the Maine/Canadian border. This language is pursuant to Section 6505 of the Affordable Care Act amending Section 1902(a) of the Social Security Act (the Act), and requires that a state shall not provide any payments for items or services provided under the State Plan or under a waiver to any financial institution or entity located outside of the United States (U.S.).
28. Section 1.15, removal of language regarding Section 113 Non-Emergency Transportation (NET) of the MaineCare Benefits Manual. Section 113 sets forth the policy for non-emergency transportation, so the duplicative language was removed from Section 1.15.
29. Termination from participation language that was in former Section 1.03-4 has been moved to new Section 1.19 entitled “Termination from Participation in MaineCare.”
30. Section 1.20(Z) & (AA), addition of two new grounds for sanctions: (1) an entity that is an HMO or is providing services under a Medicaid waiver program, and has a substantial contractual relationship with an entity that could be excluded from the Medicaid program; (2) if a provider has been convicted of a crime while performing services as a health care worker or provider. This change is being made to conform with the requirements of Section 1902 of the Social Security Act (42 USC 1396a). 
31. Section 1.20-2(C), addition of a sanction action for limitation of services for which the provider is authorized to perform and receive payment. This change adds a sanction that may occur as a result of a grounds for sanction described in 1.20-1 (Grounds for Sanctions).
32. The Department is adopting a new provision, Section 1.21, entitled “Reinstatement from Termination or Exclusion.” Reinstatement language that was in former Section 1.19-4(F) has been moved to this new section. The Department is also making the change that requests for reinstatement from exclusion or termination be addressed to the Manager of Program Integrity, in writing. The language also sets forth factors that will be considered by the Department when making a decision to reinstate. The adopted language, in Subparagraph 2, also sets forth minimum periods of time before reinstatement can be considered, for certain violations of law or other exclusion or termination reasons. The time period requirements are consistent with the time period requirements imposed on the Federal Secretary of HHS in the Social Security Act Section 1128 (as codified in 42 USC 1320a-7) (“Exclusion of Certain Individuals and Entities from Participation I Medicare and State Health Care Programs”).
33. Removal of references to the term “mentally retarded.” This term was replaced by the term “intellectually disabled.” This change follows the direction of Rosa's Law, Public Law 111-256, which requires the federal government to change terminology in federal statute to eliminate use of the term “mental retardation.”
34. Replacement of the term “Authorized Agent” with the term “Authorized Entity.” This change is being adopted across the agency in order to more accurately describe the Department’s relationship with the aforementioned entities. Contractors with the state are not legal agents of the state, so the term was replaced with “entity” to avoid confusion.
35. 1.25, changes to the language describing the duties, role, and composition of the MaineCare Advisory Committee (MAC) in order to more closely align with federal requirements, as outlined in 42 CFR  431.12.
36. Minor grammar and punctuation edits have also been made.
Finally, as a result of public comments and further review by the Department and the Office of the Attorney General, there were additional technical changes, formatting updates, and changes to language for clarity. The Summary of Public Comments and Department Responses document identifies changes that were made to the final rule.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: July 5, 2017
AGENCY CONTACT PERSON: Thomas M Leet, Comprehensive Health Planner, Division of Policy, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207)-624-4068. Fax: (207) 287-1864. TTY users call Maine relay 711. Email: Thomas.Leet@Maine.gov .
OMS WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov .

AGENCY: 99-346 - Maine State Housing Authority (MaineHousing)
CHAPTER NUMBER AND TITLE: Ch. 19, Homeless Solutions Rule
ADOPTED RULE NUMBER: 2017-106
CONCISE SUMMARY: The replacement rule repeals and replaces the current Homeless Solutions Rule. The replacement rule amends the funding formula allocation by changing the definition of “Clients Assessed and Stabilized" and provides for a one-time payment adjustment.
EFFECTIVE DATE: July 11, 2017
AGENCY CONTACT PERSON / MAINEHOUSING RULEMAKING LIAISON: Linda Uhl, Chief Counsel, Maine State Housing Authority, 353 Water Street, Augusta, Maine, 04330-4633. Telephone: (207) 626-4600. Maine Relay 711. Email: LUhl@MaineHousing.org .
AGENCY WEBSITE: http://www.mainehousing.org .

AGENCY: 99-346 - Maine State Housing Authority (MaineHousing)
CHAPTER NUMBER AND TITLE: Ch. 24, Home Energy Assistance Program Rule
ADOPTED RULE NUMBER: 2017-107
CONCISE SUMMARY: This replacement rule repeals and replaces in its entirety the current Home Energy Assistance Program Rule. The replacement rule: (i) eliminates asset test for minor, low cost work for the Central Heating Improvement Program (CHIP) and only requires it for higher cost system replacements; (ii) excludes from Household's income calculation any income from a qualifying full-time college student; (iii) adds clarifying language regarding how the benefit is determined for CHIP heating system replacement, when assets exceed the allowable threshold; (iv) simplifies the application process for an applicant whose dwelling does not have electricity or water; (v) expands allowable Energy Crisis Intervention Program (ECIP) expenditures to include additional intervention measures; and (vi) excludes the value of primary residence as an asset when determining eligibility for a heating system replacement.
EFFECTIVE DATE: July 11, 2017
AGENCY CONTACT PERSON / MAINEHOUSING RULEMAKING LIAISON: Linda Uhl, Chief Counsel, Maine State Housing Authority, 353 Water Street, Augusta, Maine, 04330-4633. Telephone: (207) 626-4600. Maine Relay 711. Email: LUhl@MaineHousing.org .
AGENCY WEBSITE: http://www.mainehousing.org .