December 22, 2021

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

AGENCY: 01-026 - Department of Agriculture, Conservation, and Forestry (DACF), Board of Pesticides Control
CHAPTER NUMBER AND TITLE: Board of Pesticides Control Rules:
Amendments to Ch. 20, Special Provisions
Amendments to Ch. 41, Special Restrictions on Pesticide Use
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2021-232, 233
BRIEF SUMMARY: The proposed rules amendments were sought to address the directives in the following bills passed by the 130th Maine Legislature: LD 316, LD 155, and LD 264. These proposed rule amendments include the requirement of two PFAS related affidavits for pesticide registrants, prohibiting the use of chlorpyrifos, and restricting the use of most neonicotinoids for residential landscape (turf and ornamental vegetation) management.
DETAILED SUMMARY:
Ch. 20 – Three amendments are proposed:
1. Define “Perfluoroalkyl and Polyfluoroalkyl Substances” or “PFAS”.
2. Add a requirement for registrants to submit a confidential statement of formula to register their product with the state of Maine.
3. Add two affidavit requirements; one affidavit that asks registrants to disclose if their pesticide product has ever been stored in a fluorinated high-density polyethylene container and a second affidavit asking registrants to disclose if the formulation of the pesticide product contains any perfluoroalkyl or polyfluoroalkyl substances.
Ch. 41 – Two amendments are proposed:
1. Add a new section pertaining to neonicotinoids (dinotefuran, clothianidin, imidacloprid or thiamethoxam) to restrict registration and prohibit use in outdoor residential landscapes for the purposes of managing pests in turf and ornamental vegetation. Add a clause allowing use for management of invasive invertebrate pests in ornamental vegetation.
2. Add a new section prohibiting the use of chlorpyrifos, except for licensed applicators who obtain a use permit from the Board to apply chlorpyrifos products purchased prior to December 31, 2022.
PUBLIC HEARING: Remote meeting, Friday, January 14, 2022 @ 9:00 a.m. via Microsoft Teams (https://teams.microsoft.com/l/meetup-join/19%3ameeting_YjBjNmI4OWYtYWYwZS00NDliLWE1ZmYtYTI5NzUxNzU2YTM4%40thread.v2/0?context=%7b%22Tid%22%3a%22413fa8ab-207d-4b62-9bcd-ea1a8f2f864e%22%2c%22Oid%22%3a%22ed6764cf-969a-43c1-907c-b3249fe5d929%22%7d )
COMMENT DEADLINE: 8:00 a.m., Monday, January 24th, 2022
CONTACT PERSON FOR THIS FILING / SMALL BUSINESS IMPACT INFORMATION / BOARD RULEMAKING LIAISON: Megan Patterson, Board of Pesticides Control, 28 State House Station, Augusta, ME 04333. Telephone: (207) 287-2731. Email: Megan.L.Patterson@Maine.gov.
FINANCIAL IMPACT ON MUNICIPALITIES OR COUNTIES (if any): 
STATUTORY AUTHORITY FOR THESE RULES:
Ch. 20—22 MRS §§ 1471-A-X
Ch. 41—5 MRS §§ 8051 et seq.
Ch. 41—7 MRS §§ 601-610
Ch. 41—22 MRS §§ 1471-A-D,M
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED: N/A
BOARD WEBSITE: https://www.maine.gov/dacf/php/pesticides/index.shtml.
DACF WEBSITE: https://www.maine.gov/dacf/.
DACF RULEMAKING LIAISON: Shannon.Ayotte@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. II Section 90, Physician Services
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2021-P234
CONCISE SUMMARY: This proposed rulemaking seeks to make the following changes:
Pursuant to PL 2021 ch. 398 sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023 (the “Budget”), and in alignment with the recommendations from the comprehensive rate setting evaluation conducted by Myers and Stauffer at the request of the Department, the proposed rule increases the reimbursement rate from 70% of the lowest level in the 2009 Medicare fee schedule to 72.4% of the current year’s Medicare rate per code. In addition, the proposed rule sets the reimbursement rates for select primary care services at 100% of current Medicare rates, from 100% of 2014 Medicare rates, for eligible primary care providers, which is an additional reimbursement increase. These reimbursement changes shall be effective July 1, 2022, as authorized and required by the Budget.
Also per the Budget, the proposed rule adds a new provision, Section 90.04-7(B), Physician-Administered Drugs that have Biosimilar Equivalents and/or Prior Authorization Criteria. This provision implements a Biosimilar Preferred Drug List which establishes preferred and non-preferred drug statuses based on cost and biosimilar equivalency for physician-administered drugs. Physician-administered drugs are those that satisfy the criteria in 90.04-7(A), but they also may be drugs administered orally. For drugs that are not administered orally, the proposed changes require providers not only to go through the steps set forth in 90.04-7(A), but also to use physician-administered biosimilar drugs when a physician-administered drug has a Food and Drug Administration- (FDA) approved, biosimilar equivalent that the Department identifies as more affordable. Annually, the Department shall identify drugs that have a more affordable FDA-approved biosimilar equivalent on the Biosimilar Preferred Drug List on the MaineCare Health PAS Online Portal. Physicians shall submit a PA request to administer the original drug. For physician-administered drugs that are administered orally, providers must satisfy the requirements in 90.04-7(B).
Section 90.04-7 also requires that some physician-administered drugs may require PA to ensure members meet age, clinical, or other requirements for MaineCare to provide payment and that the MaineCare Health PAS Online Portal contains a complete list of physician-administered drugs that require PA and corresponding PA criteria sheets. Providers must make requests for PA on the Department’s approved form and get approval prior to the date of service. This new proposed PA process is in addition to the requirements for PA in 90.04-7(A).
The proposed rule (sec. 90.04-30) allows members under the age of 21 to receive the application of topical fluoride varnish up to four times per calendar year from eligible providers, rather than two times per calendar year or three times for members with a high caries rate or new restorations placed in the last 18 months. This change aligns with other states’ Medicaid program limitations on fluoride treatment and the current American Academy of Pediatrics recommendation on fluoride treatment. The proposed rule (sec. 90.04-31) also allows all members to receive an oral health risk assessment if they do not have a dental home and/or have not seen a dentist in the past year, rather than restricting the service to members under three years of age.
The proposed rule (sec. 90.05-2(A)) clarifies that medication abortions are covered and shall be performed in compliance with applicable Food and Drug Administration law and guidelines.
The 130th Maine Legislature enacted PL 2021 ch. 348, An Act to Discontinue the Use of the Terms "Handicap," "Handicapped" and "Hearing Impaired" in State Laws, Rules and Official Documents. The proposed rule replaces the term ‘handicapped’ with ‘person with disabilities’ pursuant to PL 2021 ch. 348.
This section 90 rulemaking also proposes to eliminate sec. 90.09-4, Primary Care Provider Incentive Payment (PCPIP), as part of the new Primary Care Plus (PCPlus) initiative. PCPIP authorizes an incentive payment to primary care practices (PCP) based on their performance on several access, utilization, and quality measures. Retaining this payment after PCPlus takes effect would be duplicative of the reimbursement PCPs will receive under the new PCPlus rule. PCPs who currently receive the Incentive Payment may instead apply to participate in PCPlus and, if approved as part of the program, will receive reimbursement based on their performance for members attributed to their practice.
To complete the transition to PCPlus, the Department shall also propose to significantly revise MBM, ch. II sec. 91 (proposed to be titled “Health Home Services – Community Care Teams), which includes repealing Health Home Practices. All of these rulemakings make up the PCPlus initiative, will be proposed simultaneously, and will have the same effective date.
The PCPlus program is intended to give primary care providers (PCPs) greater flexibility and incentives to effectively meet MaineCare members’ health care needs by transitioning away from a volume-based (fee-for-service) payment system with little connection to value, toward an approach that provides risk-adjusted Population-Based Payments tied to cost- and quality-related outcomes To receive reimbursement under PCPlus, providers are required to locate, coordinate, and monitor health care services for members who are attributed to them. The Department will continue to reimburse other MaineCare covered services under the fee-for-service system. Interested parties should refer to the new PCPlus rule (MBM ch. VI sec. 3) for more details.
The Department shall seek approval from the Centers for Medicare and Medicaid Services (CMS) of state plan amendments (SPAs) to repeal and revise the aforementioned programs and implement the PCPlus program. Additionally, the Department will publish notice of the changes in Section 90 reimbursement methodology pursuant to 42 CFR §447.205.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
PUBLIC HEARING: No public hearing is scheduled. The Department will provide a 30-day comment period instead of a public hearing.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on January 21st, 2022.
OMS CONTACT PERSON: Henry Eckerson, Comprehensive Health Planner II, MaineCare Services, 109 Capitol Street - 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4085. Fax: (207) 287-6106. TTY: 711 (Deaf or Hard of Hearing). Email: Henry.Eckerson@Maine.gov.
IMPACT ON MUNICIPALITIES OR COUNTIES: The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION: N/A
STATUTORY AUTHORITY FOR THIS RULE: 22 MRS §§ 42, 3173; PL 2021 ch. 398 sec. A-17; PL 2021 ch. 348
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
OMS WEBSITE: https://www.maine.gov/dhhs/oms.
OMS RULEMAKING LIAISON: Jennifer.Patterson@Maine.gov.
DHHS WEBSITE: https://www.maine.gov/dhhs/.
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. II and III Section 91, Health Home Services
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2021-P235
CONCISE SUMMARY: This section 91 rulemaking proposes to eliminate Health Home Practices (HHP) from the section 91 rule, makes various changes to Community Care Teams (CCTs), establishes the Housing Outreach and Member Engagement Provider (HOME Provider) as a provider of specialized CCT services and adds affiliated reimbursement rates to ch. III section 91, and changes the names of the ch. II and III section 91, policies to “Health Home Services – Community Care Teams”.
Health Home Practices and the PCPlus Initiative
HHPs are primary care practices that have been approved by MaineCare to provide Health Home Services. In this section 91 rulemaking, the Department eliminates HHPs as providers in section 91 because it would be duplicative of the covered services and reimbursement which the members and primary care providers (PCPs), respectively, will receive via the new Primary Care Plus (PCPlus) program. To complete the transition to PCPlus, the Department shall also propose to repeal Primary Care Case Management (ch. VI sec. 1) and the Primary Care Provider Incentive Payment within ch. II sec. 90 (Physician Services).
The PCPlus program is intended to give PCPs greater flexibility and incentives to effectively meet MaineCare members’ health care needs by transitioning away from a volume-based (fee-for-service) payment system with little connection to value, toward an approach that provides risk-adjusted Population-Based Payments tied to cost- and quality-related outcomes. To receive reimbursement under PCPlus, providers are required to locate, coordinate, and monitor health care services for members who are attributed to them, as set forth in the PCPlus rule, section 3.04. The Department will continue to reimburse other MaineCare-covered services under the fee-for-service system. PCPs who are currently HHPs may apply to participate in the soon-to-be-implemented PCPlus program and, if approved, will receive reimbursement based on their practice level characteristics and performance for members attributed to their practice. Interested parties should refer to the new PCPlus rule (MBM, ch. VI sec. 3) for more details.
The Department is seeking and anticipates approval from the Centers for Medicare and Medicaid Services (CMS) of state plan amendments (SPAs) to repeal and/or alter these programs and implement the PCPlus program. Additionally, the Department will publish notices of the changes in reimbursement methodology pursuant to 42 CFR §447.205.
Members currently attributed to an HHP panel will not experience any direct impacts once the HHP rule provisions are repealed. Members will keep their PCPs, but those PCPs that were HHPs will no longer be held to the HPP provider and covered service requirements. Members will be notified of the HHP repeal if their PCP is currently an HHP and if their PCP becomes a PCPlus provider.
Community Care Teams
Under the proposed rule, CCTs support PCPs, rather than HHPs, by providing services to members who are high-risk and/or high-cost and whose health care needs are more intense than can be managed by a PCP. The proposed rule expands, simplifies, clarifies, and removes redundancies from the covered service requirements.
Under this proposed rule, CCTs will be subject to new provider requirements. CCTs must implement an electronic health record, participate in Department-required technical assistance and educational opportunities, maintain a Participant Agreement for data sharing with Maine’s Health Information Exchange, follow ten core standards currently designed for and applied to HHPs under the current rule, have a documented relationship with one or more PCPs, and have a multidisciplinary team of at least three health care professionals whose roles have been clarified.
The proposed rule also changes member eligibility requirements for CCT services to be more inclusive by decreasing the number of chronic medications, hospital admissions, and emergency department visits that are needed to qualify a member. Members would also now be eligible if they are transitioning from an institutional setting and if members are identified by risk-stratification as at risk for deteriorating health; high-risk or high-cost due to severity of illness or high social needs; or higher health care needs than is expected for their clinical risk group. To receive CCT services Members must still have two or more chronic conditions or have one chronic condition and be at risk for another. The proposed rule also adds new risk factors that would make a member at risk for a chronic condition.
Housing Outreach and Member Engagement (HOME) Services and Providers
Via Resolve, To Increase Access to Housing-related Support Services,LD 1318 (129th Legislature 2019), the Legislature directed the Department to examine federal opportunities to provide housing-related services to persons experiencing chronic homelessness who have mental health conditions or substance use disorder and other vulnerable populations. In addition, the Office of MaineCare Services, Maine State Housing Authority (MSHA), and various housing and homeless services providers applied for and were accepted into a Medicaid Innovation Accelerator Program (IAP) for State Medicaid-Housing Agency Partnerships with technical assistance from the Corporation for Supportive Housing (CSH) and the Center for Health Care Strategies (CHCS). The collaborative group focused on improving outcomes for MaineCare members with disabilities and chronic health conditions, including Substance Use Disorder (SUD), who are experiencing homelessness and developing a Medicaid benefit to support housing sustainability, improved health outcomes, and reduced overall costs of care. The group proposed to use Section 2703 of the Affordable Care Act to develop a new type of CCT, a “HOME Provider,” that would provide comprehensive care management and medical and behavioral health care coordination with intensive levels of transitional care and individual supports to meet the needs of MaineCare members with long-term homelessness.
HOME Providers shall conduct outreach to underserved populations in need of intensive HOME services due to high emergency services utilization, chronic conditions, complex care coordination needs, and long-term homelessness. The HOME Provider shall be comprised of a manager, clinical leader, case manager, peer support staff, and housing navigator. HOME Providers shall receive and review referrals for HOME service eligibility and enrollment from any point of care, including but not limited to hospitals, medical and behavioral health providers, and community service organizations. HOME Providers shall provide comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support services, and referral to community and social support services. There are three HOME service tiers in which members can be enrolled. Members must first meet the Intensive Tier criteria before entering the Stabilization and Maintenance Tiers. Each tier represents an intensity level of covered services and has a different per member per billing month reimbursement amount. Eligible members who are children may receive covered HOME services, as long as the HOME Provider obtains written consent from a parent or legal guardian.
Lastly, this rulemaking requires both CCTs and HOME Providers to submit data necessary to compile and report on performance measures, as identified by the Department. This will aid in the development of value-based metrics to include in future iterations of rulemaking and to ensure that the services provided are high-quality. The rulemaking also defines “billing month” as the period from the 21st of a month to the 20th of the following month and, when appropriate, replaces “month” and “calendar month” with “billing month” to clarify the reimbursement period for providers.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
PUBLIC HEARING: No public hearing is scheduled. The Department will provide a 30-day comment period instead of a public hearing.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on January 21st, 2022.
OMS CONTACT PERSON: Henry Eckerson, Comprehensive Health Planner II, MaineCare Services, 109 Capitol Street - 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4085. Fax: (207) 287-6106. TTY: 711 (Deaf or Hard of Hearing). Email: Henry.Eckerson@Maine.gov.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION: N/A
IMPACT ON MUNICIPALITIES OR COUNTIES: The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
STATUTORY AUTHORITY FOR THIS RULE: 22 MRS §§ 42, 3173; section 2703 of the Affordable Care Act; LD 1318 (129th Legislature 2019), Resolve, To Increase Access to Housing-related Support Services; P.L. 2021, ch. 398, Sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
OMS WEBSITE: https://www.maine.gov/dhhs/oms.
OMS RULEMAKING LIAISON: Jennifer.Patterson@Maine.gov.
DHHS WEBSITE: https://www.maine.gov/dhhs/.
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. VI Section 3, Primary Care Plus
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2021-P236
CONCISE SUMMARY: This proposed rulemaking repeals 10-144 CMR ch. 101, MaineCare Benefits Manual (the “MBM”), ch. VI sec. 1, Primary Care Case Management (PCCM), and replaces it with MBM ch. VI sec. 3, Primary Care Plus (PCPlus), a single integrated program for MaineCare’s current primary care programs. To complete the transition to PCPlus, the Maine Department of Health and Human Services (the “Department”) shall also propose to repeal MBM ch. II sec. 90.09-4 (Primary Care Provider Incentive Payment) and shall propose to significantly revise MBM ch. II sec. 91 (proposed to be titled “Health Home Services – Community Care Teams”), which includes repealing Health Home Practices. All of these rulemakings make up the PCPlus initiative, will be proposed simultaneously, and will have the same effective date.
The Department shall seek approval from the Centers for Medicare and Medicaid Services (CMS) of state plan amendments (SPAs) to repeal the aforementioned programs and implement the PCPlus program. Additionally, the Department will publish a notice of change in reimbursement methodology pursuant to 42 CFR §447.205.
Overview of the PCPlus Initiative
The Department and the Office of MaineCare Services (OMS) are committed to improving health care access and outcomes for MaineCare members, demonstrating cost-effective use of resources, and creating an environment where providers can innovate in delivering high-value care. PCPlus is part of OMS’ commitment to have 40% of MaineCare expenditures paid through Alternative Payment Models (APMs) by the end of 2022. APMs are health care payment methods that use financial incentives to promote or leverage greater value, indicated by higher quality care and/or lower costs.
PCPlus is considered an “Integrated Care Model” by CMS under State Medicaid Director Letter #12-002, aligns with the Center for Medicare and Medicaid Innovation’s (CMMI) Primary Care First Model (See also: https://innovation.cms.gov/innovation-models-options), and operates under the authority of Section 1905(t)(1) of the Social Security Act (SSA). The PCPlus program is intended to give primary care providers (PCPs) greater flexibility and incentives to effectively meet MaineCare members’ health care needs by transitioning away from a volume-based (fee-for-service) payment system with little connection to value, toward an approach that provides risk-adjusted Population-Based Payments tied to cost- and quality-related outcomes.
Participation in PCPlus is voluntary for PCPs. For PCPs that elect to participate, the Department will share quality and utilization data, offer a new value-based payment model, and provide technical assistance to assist practices transform care delivery and achieve performance outcomes. The new payment model is risk-based, meaning reimbursement will increase or decrease depending on the PCPlus provider’s performance, as set forth in Section 3.08 of the rule. Providers may appeal Departmental actions, pursuant to chapter I section 1.
Member participation in this model is based on which PCP the member visited for health care services or by the members’ identification of a PCP through calling MaineCare Member Services. Member participation is voluntary and does not interfere with MaineCare members’ freedom of choice to access other MaineCare providers. If a member identified their PCP for attribution through MaineCare Member Services but does not receive at least one primary care service from their selected PCP within one year, then DHHS will notify and reattribute the member in accordance with the primary care services-based attribution methodology. Members may change their PCP or opt out of PCPlus at any time.
To receive reimbursement under PCPlus, providers are required to locate, coordinate, and monitor health care services for members who are attributed to them, as set forth in Section 3.04. All covered services rendered by PCPlus providers must be documented in the member’s electronic health record. The Department will continue to reimburse other MaineCare covered services under the fee-for-service system.
Differences Between PCPlus and PCCM
CMS considers PCCM to be a form of managed care, which operates under section 1905(a)(25) of the SSA and 42 CFR 438.6 with mandatory member participation for the majority of MaineCare members. PCPlus operates under 1905(t)(1) of the SSA and is not a managed care program. Since PCPlus is not a managed care program, it does not include many of the managed care requirements that PCCM follows. For example, except as set forth in the rule, member participation in PCPlus is based on members’ selection of a PCP, members may opt out of this program, and this program has no bearing on MaineCare members’ freedom of choice to access services from any qualified MaineCare provider. In addition, PCPlus, unlike PCCM, does not include the PCCM provisions on member participation or complaints, and PCP selection, change, and reassignment.
Under PCCM and PCPlus, providers locate, coordinate, and monitor health care services. However, PCPlus expands service and practice requirements to support whole-person coordination and transitions of care; completing timely prior authorizations; providing, tracking, and following up on referrals; and closing care gaps, including a focus on preventative services.
PCCM providers who choose to participate in PCPlus will benefit from a new value-based payment model, which includes a risk-adjusted population-based payment tied to cost- and quality-related outcomes, rather than the flat per member per month management fee provided under PCCM. Given the additional requirements and support for providers, PCPlus should improve health outcomes for members.
Section 90 and 91 Rulemakings for PCPlus Initiative
Regarding the related proposed rulemaking for section 90, the Department is eliminating the Primary Care Provider Incentive Payment because it would duplicate the reimbursement model of the new PCPlus program. Physicians who currently receive the Incentive Payment may apply to be PCPs under the PCPlus program, and, if approved, will receive reimbursement based on the PCPlus service expectations and performance for members attributed to their practice.
For section 91, as it relates to the PCPlus initiative, the Department is removing Health Home Practices (HHPs) because they would be duplicative of the reimbursement the PCPs will receive and the covered services they provide via PCPlus. HHPs that currently receive reimbursement through Section 91 may apply to participate in the PCPlus program, and, if approved, PCPs will receive reimbursement based on the PCPlus service expectations and performance for members attributed to their practice.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
PUBLIC HEARING: No public hearing is scheduled. The Department will provide a 30-day comment period instead of a public hearing.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on January 21st, 2021.
OMS CONTACT PERSON: Henry Eckerson, Comprehensive Health Planner II, MaineCare Services, 109 Capitol Street - 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4085. Fax: (207) 287-6106. TTY: 711 (Deaf or Hard of Hearing). Email: Henry.Eckerson@Maine.gov.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION: N/A
IMPACT ON MUNICIPALITIES OR COUNTIES: The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
STATUTORY AUTHORITY FOR THIS RULE: 22 MRS §§ 42, 3173; Social Security Act §1905(t)(1) (42 USC §1396d(t)(1))
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
OMS WEBSITE: https://www.maine.gov/dhhs/oms.
OMS RULEMAKING LIAISON: Jennifer.Patterson@Maine.gov.
DHHS WEBSITE: https://www.maine.gov/dhhs/.
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. VII Section 5, Estate Recovery
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2021-P237
CONCISE SUMMARY: This final rule is proposed to implement PL 2021 ch. 398 part A §A-1, pg. 99, which provided funding to modify MaineCare estate recovery rules to conform with the minimum mandatory federal requirements, which are set forth in 42 USC 1396p(b).
Ch. VII section 5, “Estate Recovery”, of the MaineCare Benefits Manual (MBM), has been modified by emergency rulemaking, filed November 24, 2021. The permanent rule is as follows: Effective November 24, 2021, the Department’s estate recovery claim is limited to the amount paid by MaineCare for all nursing facility services, home and community-based services, and related hospital and prescription drug services paid on behalf of the Member. This proposed rule makes the emergency rule permanent with an effective date of November 24, 2021.
In addition, the Department proposes to update language regarding life estates to clarify the definition, as well as how life estates are valued.
The Department has also removed conditional language regarding CMS’s pending approval of previous changes if those changes have since been approved and has made minor typographical corrections.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
PUBLIC HEARING: A public hearing will not be held for this rulemaking. The Department will accept email and standard mail comments for 30 days following rule filing with the Secretary of State. Email to Nicole.Jurdak@Maine.gov and standard mail to Nicole Jurdak, 11 SHS, 109 Capitol Street, Augusta, ME 04330.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on January 21, 2022.
OMS CONTACT PERSON: Nicole Jurdak, Comprehensive Health Planner, Office of MaineCare Services, 109 Capitol Street - 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4058. Fax: (207) 287-6106. TTY: 711 (Deaf or Hard of Hearing). Email: Nicole.Jurdak@Maine.gov .
IMPACT ON MUNICIPALITIES OR COUNTIES: The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A
STATUTORY AUTHORITY: 22 MRS §§ 42, 3173, 42(8)
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
OMS WEBSITE: https://www.maine.gov/dhhs/oms.
OMS RULEMAKING LIAISON: Jennifer.Patterson@Maine.gov.
DHHS WEBSITE: https://www.maine.gov/dhhs/.
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov.

AGENCY: 94-457 - Finance Authority of Maine (FAME)
CHAPTER NUMBER AND TITLE: Ch. 620, Maine Health Care Provider Loan Repayment Pilot Program
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2021-P238
BRIEF SUMMARY: The rule implements legislation recently enacted by the Legislature during the First Regular Session of the 130th Maine Legislature as part of LD 1733, (now PL 2021 ch. 483 (part H)), the bill directing various federal relief funds as a result of American Rescue Plan Act of 2021 (ARPA). The Maine Health Care Provider Loan Repayment Pilot Program Fund will make loan repayments to eligible program participants to address critical workforce shortages exacerbated by the COVID-19 pandemic, including, but not limited to, the behavioral health and oral care sectors. The program will be geared toward certain health care professionals who commit to living and working in Maine for at least three years. Under the program, FAME shall pay up to $25,000 per year and, in aggregate, the lesser of $75,000 and 50% of the recipient's outstanding loan balance. The program terminates when the funds allocated are fully expended or by December 31, 2024, whichever occurs first, unless other funding is made available to carry out the purpose of the program.
PUBLIC HEARING: None. One would be scheduled at the request of 5 or more parties.
COMMENT DEADLINE: January 24, 2022
CONTACT PERSON FOR THIS FILING / SMALL BUSINESS IMPACT INFORMATION: William Norbert, Governmental Affairs and Communications Manager, Finance Authority of Maine, PO Box 949 - 5 Community Drive, Augusta, ME 04332-0949. Telephone: (207) 620-3540 or 1 (800) 228-3734. Fax: (207) 213-2615. TTY: (207) 626-2717. Email: wnorbert@famemaine.com.
FINANCIAL IMPACT ON MUNICIPALITIES OR COUNTIES: None anticipated.
STATUTORY AUTHORITY FOR THIS RULE: PL 2021 ch. 483 (part H)
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
FAME WEBSITE: www.famemaine.com.
FAME RULEMAKING LIAISON: croney@famemaine.com.

ADOPTIONS

AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office for Family Independence (OFI)
CHAPTER NUMBER AND TITLE: Ch. 301, Supplemental Nutrition Assistance Program (SNAP) Rules (formerly Food Supplement Program): Cover Page, Alpha Index, Table of Contents, and Sections: 111-1, 111-3, 111-8, 222-1, 222-4, 222-5, 222-6, 222-7, 333-1, 333-2, 444-4, 444-7, 444-8, 444-10, 444-11, 555-1, 555-3, 555-4, 555-6, 555-7, 666-6, 666-9, 777-7, 999-1, and 999-3: SNAP Rule #212A, 2021 Omnibus rule change
ADOPTED RULE NUMBER: 2021-256
CONCISE SUMMARY: This rule change implements many changes required by state statute or federal regulation. It aligns Maine policy with various federal waivers and options. It makes non-substantive changes to improve the readability and inclusivity of the manual, reduce the use of stigma inducing language, and update the names of programs such as WIOA and TANF. It corrects various citations.
The Department is changing the terms “Food Supplement” and “Food Supplement Program” to “Supplemental Nutrition Assistance Program” and, by extension, their associated abbreviations to “SNAP”. This change is consistent with the terminology used in federal law and regulation as well as signage and other materials seen throughout the state and nation. Furthermore, PL 2021 c. 398 part OO made this change throughout Maine’s revised statutes. This change is reflected in the name of the chapter itself and all uses of the terms and abbreviations in sections included in this rulemaking (unless they refer only to a time prior to the statutory change). The “FS” is removed from all section numbers.
The Department is using person first language wherever feasible and replacing terms intended to convey the same meaning with “Substance Use Disorder”. These changes are consistent with PL 2017 c. 407 part B, PL 2021 c. 348, and generally accepted best practices. There are occasional exceptions to this effort where it was determined best to keep the language consistent with the relevant federal statute.
The Department is converting some phrases to active voice and simplifying the representation of numbers as part of an ongoing, office-wide effort at standardization and clarity.
The Department is adding clarity to Section 111-1 related to standards and process for determining separate household status.
This rule change aligns the chapter with the approved waiver submitted under the requirements of 22 MRS §3104(17) (as amended by PL 2019 c. 492 §1). This waiver allows residents of state or county correctional facilities to submit an application for SNAP up to 30 days prior to release, and for the filing date of the application to be the date of release.
The Department is removing references to an application needing to be dated. This change aligns the chapter with 7 CFR §273.2(c)(1)(iii).
The Department is amending the chapter to eliminate disqualifications based on non-compliance with child support orders. This policy was in place as part of a state option authorized under 7 CFR §273.11(q). The Department is choosing to no longer exercise that option. This change is effective December 1, 2021. Retroactive rulemaking is permissible under 22 MRS §42(8) as the change affords this benefit to more residents of the State of Maine and does not adversely impact applicants, participants, beneficiaries, or providers.
The Department is aligning the disqualification periods for Quality Control noncompliance with those found in 7 CFR §273.2(d)(2).
The Department is clarifying, in Section 222-5, that a “reasonable opportunity” to resolve discrepancies is 10 days.
The Department is amending the chapter to eliminate the asset limit for all households effective January 1, 2022. This change is required by PL 2021 c. 115 and improves access for residents with low income.
The Department is removing language from Section 333-1 excluding the assets of ineligible students, non-citizens, alien sponsors as it is redundant to language in 444-4.
The Department is making a number of changes to the sections on assets. This rule change updates the asset and income lists to reflect new technologies such as non-fungible assets and crypto-currency. It further amends the language related to assets and income excluded by federal statute to reflect the fact that new statutes may be passed excluding certain resources not on the existing list. These resources are often of a temporary nature, such as those created through various legislation associated with COVID-19. To add and remove them from the chapter each time there is a federal law change would be an unnecessary administrative burden and duplicative of action already taken by Congress. Additionally, the acceptable verifications of a good faith effort to sell real property are updated to conform with 7 CFR §273.8(e)(8).
The Department is aligning the look back period for certain felonies with the one required by 7 CFR §273.11(s)(3).
The Department is limiting comparable disqualifications related to disqualifications from other means tested programs to instances where the individual has been found by a court or administrative hearing to have committed an intentional program violation (IPV) or has signed an IPV waiver. Maine is one of only 13 U.S. states or territories to apply comparable sanctions for non-compliance with other program’s requirements. This change aligns Maine with the majority of other SNAP agencies. This policy was in place as part of a state option authorized under 7 CFR §273.11(k). Under that same authority, the Department is choosing to less fully exercise that option.
The Department is amending the work requirement for post-secondary students to allow for weekly hours to be averaged over the month. This change aligns this requirement with other work requirements in the chapter while remaining consistent with 7 CFR §273.5(b)(5).
A more detailed description of the Resource Guide for Families is added to Section 444-5.
The Department is updating Section 555-6 to more clearly and accurately describe the budgeting process. Accordingly, the budgeting worksheet in Section 555-7 that is redundant to the budgeting process outlined in 555-6 without adding clarity is eliminated.
The Department is clarifying that, if there is an interruption in or delay of benefits as a result of household action or inaction, benefits for the month the situation is resolved will be prorated to the date of compliance. This change is required as part of Maine’s reinstatement waiver approved August 16, 2021 and guidance provided in Food and Nutrition Services memo index number 88-04.
The Department is cleaning up language in Section 666-6 that was applicable prior to the statewide conversion to simplified reporting. This language is no longer relevant and could reduce the clarity of the current requirements.
The Department is clarifying the reporting requirement related to household income exceeding 130% of the federal poverty level. This change is necessary to align the chapter with the requirements at 7 CFR §273.12(a)(5)(v).
The Department is clarifying the verification requirements at annual eligibility review. This change is necessary to align the chapter with the requirements at 7 CFR §273.2(f)(8). They improve access for households and reduce the administrative burden for the Department.
The Department is delaying the changes to the expungement deadline adopted as part of Food Supplement Rule Making #218A from September 1, 2021 to September 1, 2022. This change is necessary to comply with changes to 7 CFR part 274 detailed in the Federal Register Vol. 86 No. 143. These changes at the state and federal level are necessary as the national EBT vendor could not make the technology changes necessary to implement the change prior to the original deadline while, at the same time, making the changes necessary to support the various COVID-19 related initiatives.
The Department is adding a definition of public institution to add clarity to the application process in certain circumstances.
The Department is implementing various budgeting figures as required by 7 CFR §273.9(d). It requires that SNAP income and asset limits, maximum and minimum allotments, standard deductions, maximum shelter deductions, homeless shelter deductions, standard utility allowances (SUAs) and income change reporting thresholds be updated each year, effective October 1. This year, the United States Department of Agriculture (USDA) COLA Memo FY2021 provided more generous income limits, maximum and minimum allotments, standard deductions, maximum shelter deduction, homeless shelter deduction, asset limits, and income change reporting thresholds. Each state agency is charged with determining standard utility allowances and having those approved by USDA. The utility allowance values were calculated to increase using The Consumer Price Index published by the Bureau of Labor Statistics of the Department of Labor, and were submitted to and approved by USDA. These updates were made in Food Supplement Emergency Rulemaking #222E. This rulemaking continues these changes beyond December 30, 2021.
As proposed, Section 444-8(6) of this rulemaking would have eliminated the $0 benefit starting March 1, 2022 and implemented over a 12-month period. Upon further review, the Department recognizes that these households benefit from SNAP Employment and Training supports. Therefore, the $0 benefit will be retained.
A typographical error in the proposed rulemaking would have the Federal Fiscal Year (FFY) 2021 and 2022 figures in Chart 8 overlap. This error has been corrected by updating the end date of the FFY 2021 figures to September 30, 2021.
See http://www.maine.gov/dhhs/ofi/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: Thursday, December 30, 2021
OFI CONTACT PERSON: Ian Miller, Senior Program Manager, SNAP, Department of Health and Human Services - Office for Family Independence, 109 Capitol Street – 11 State House Station, Augusta, ME 04330-6841. Telephone: (207) 624-4138. Fax: (207) 287-3455. TT Users Call Maine Relay – 711. Email: Ian.Miller@Maine.gov .
OFI WEBSITE: https://www.maine.gov/dhhs/ofi .
OFI RULEMAKING LIAISON: Dan.Cohen@Maine.gov . .
DHHS WEBSITE: https://www.maine.gov/dhhs/.
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov.

AGENCY: 10-144 - Department of Health and Human Services (DHHS), Maine Center for Disease Control and Prevention (Maine CDC)
CHAPTER NUMBER AND TITLE: Ch. 234, Lead Testing In School Drinking Water Rule
ADOPTED RULE NUMBER: 2021-257
CONCISE SUMMARY: The DHHS Maine CDC is adopting a new major substantive rule to comply with 2019 PL ch. 158, An Act to Strengthen Testing for Lead in School Drinking Water, codified at 22 MRS §2604-B. The Act directs the Department to adopt a major substantive rule and establish the following: drinking water testing protocols for lead in all Maine schools, a standard of lead in school drinking water, abatement and mitigation methods, as well as public notification and reporting protocols.
EFFECTIVE DATE: January 12, 2022
MAINE CDC CONTACT PERSON: Andrew Hardy, Maine CDC, 11 State House Station - 286 Water Street, Augusta ME 04333-0011. Telephone: (207) 287-4490. Email: Andrew.Hardy@Maine.gov.
MAINE CDC RULES WEBSITE: http://www.maine.gov/dhhs/mecdc/rules/.
MAINE CDC RULEMAKING LIAISON: Tera.Pare@Maine.gov.
DHHS WEBSITE: https://www.maine.gov/dhhs/.
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov.

AGENCY: 02-031 - Department of Professional & Financial Regulation (PFR), Bureau of Insurance
CHAPTER NUMBER AND TITLE: Ch. 391, Motor Vehicle Insurance Identification Cards
ADOPTED RULE NUMBER: 2021-258
CONCISE SUMMARY: The purpose of the amendment is to implement a new provision at 29-A MRS §1601(10), in the General Financial Responsibility subchapter, requiring that motor vehicle insurance identification cards list any person excluded from coverage under a personal motor vehicle insurance policy.
EFFECTIVE DATE: December 21, 2021
AGENCY CONTACT PERSON / RULEMAKING LIAISON: Benjamin Yardley, Senior Staff Attorney, Department of Professional & Financial Regulation (OFR) - Bureau of Insurance, 76 Northern Avenue, Gardiner, ME 04345. Telephone: (207) 624-8537. Email: Benjamin.Yardley@Maine.gov.
BUREAU WEBSITE: https://www.maine.gov/pfr/insurance/.

AGENCY: 02-029 - Department of Professional & Financial Regulation (PFR), Bureau of Financial Institutions
CHAPTER NUMBER AND TITLE: Ch. 141 (Reg. 41), Assessments – Nondepository Trust Companies, Uninsured Banks, and Merchant Banks
ADOPTED RULE NUMBER: 2021-259
CONCISE SUMMARY: This rule amends current ch. 141 (Regulation # 41), Assessments – Nondepository Trust Companies, Uninsured Banks, and Merchant Banks. This rule was last promulgated in 2009 to establish quarterly assessments and set assessment rates for state-chartered nondepository trust companies, uninsured banks, and merchant banks. The purpose of the adopted rule is to reduce the assessment fee charged to state-chartered nondepository trust companies, uninsured banks, and merchant banks from 12 cents to 9 cents per $10,000 in assets subject to assessment, and increase the minimum fee charged to state-chartered nondepository trust companies, uninsured banks, and merchant banks from $2,000 to $4,000 per year. Amended rates of assessment will become effective beginning the calendar quarter ending March 31, 2022.
EFFECTIVE DATE: January 1, 2022
BUREAU CONTACT PERSON / RULEMAKING LIAISON: David Gordon Laurendeau, Attorney, Bureau of Financial Institutions, 36 State House Station, Augusta, Maine 04333-0036. Telephone: (207) 624-8570. Email: David.G.Laurendeau@Maine.gov .
BUREAU WEBSITE: https://www.maine.gov/pfr/financialinstitutions/ .