March 16, 2022

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: 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
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2022-P031
CONCISE SUMMARY: The Department of Health and Human Services (the "Department") proposes this rule change in 10-144 CMR ch. 101, MaineCare Benefits Manual (MBM), ch. II & III section 93, “Opioid Health Home Services”, to improve access to treatment, reduce administrative barriers to providing Medication Assisted Treatment (MAT), promote evidence-based treatment standards, and reinforce the importance of Opioid Health Home (OHH) integration with primary care. The Department will submit a State plan amendment (SPA) to the Center for Medicare and Medicaid Services (CMS) for some of these changes and expects it to be approved. The proposed rule and the SP A will have the same effective date.
This rulemaking consists of the following changes in ch. II and III section 93, “Opioid Health Home Services”:
The proposed rule makes various changes to the MAT prescriber position. It allows practitioners licensed under state and federal law to order, administer, or dispense opioid agonist treatment medications to be MAT prescribers for members in the Methadone Level of Care who receive OHH services from an
Opioid Treatment Program (OTP). It requires the MAT prescriber to coordinate with the OTP OHH when members in the Methadone Level of Care receive OHH services from a non-OTP OHH. It also requires MAT prescribers to be involved in providing the services described under 93.05-1, Health Home Services.
The proposed rule makes various changes to the nurse care manager position on the OHH team. In response to requests from providers, the proposed rule allows licensed practical nurses to be nurse care managers. It requires any person serving as the nurse care manager to complete the eight-hour training for buprenorphine prescribing by physicians within six months of initiating service delivery for OHH members, unless the individual is an Advanced Practice Registered Nurse with a X-Drug Enforcement Administration (DEA) license. It no longer requires the nurse care manager to oversee and/or participate in all aspects of OHH services because the nurse care manager would not oversee opioid use disorder (OUD) counselling. It specifies that the nurse care manager position may be filled by another appropriate licensed medical professional on the OHH team, as long as the individual completes training for an XDEA license within six months of initiating service delivery for OHH members.
The proposed rule adds methadone to the medications included in the OHH model and allows an OTP to provide methadone to members. The rule also adds a statement encouraging the co-prescribing of naloxone for OHH members, as appropriate, in alignment with best practice guidelines.
The proposed rule makes a number of changes to the counseling requirement. It clarifies that counseling is not required for the Medication Plus Level of Care and is not part of the OHH bundle for the Methadone Level of Care. It changes the counseling requirement to be assessed on a monthly instead of weekly basis, which is in response to feedback that weekly requirements are too stringent for this service and are challenged by normal life events. It clarifies that counseling requirements for each clinical phase are based on a "billable" month (in alignment with standard billing practice), which does not always equate to a full 60 minutes of counseling. It requires OHH members in Intensive Outpatient (IOP) and Induction Levels of Care to engage in individual or group counseling for four billable hours per month; members in the Stabilization Level of Care for two hours; and members in the Maintenance Level of Care for one hour.
The proposed rule makes various changes to the reimbursement section. This rulemaking allows providers to bill the new Medication Plus and Methadone Levels of Care if the member is enrolled for at least one day during the billing month. It adds that OHH providers will not be reimbursed for an OHH member if that member also receives section 97, “Private Non-Medical Institution Services”; section 13, “Targeted Case Management Services”; section 17, “Community Support Services”; or section 92, “Behavioral Health Homes”, unless the section 13, 17, or 92 provider has a contract with the OHH to provide Health Home Services. The rule also adds an Additional Provider Support provision for OHH members with additional community support needs related to mental health, HIV, medical concerns and/or utilization, and/or homelessness. The Department or its authorized entity must approve additional supports provided to eligible members and reimbursed through the pass-through payment described in ch. III section 93, “Opioid Health Home Services”, including an active release of information and a contractual agreement between the OHH and additional support provider.
The rule also adds a pay-for-performance provision which withholds four percent of total OHH PMPM payments. This amount shall be paid to providers every six months if they satisfy the minimum performance threshold, and providers who meet the excellent performance threshold are eligible to receive any additional available amount. The Department shall set the performance thresholds so that no less than 70% of eligible OHHs are expected to be above the minimum performance threshold and no less than 20% of OHHs are expected to be above the excellent performance threshold. This means that 30% of eligible OHHs are not expected to meet the minimum performance threshold and thus will not receive the four percent payment. Those four percent amounts will be combined and distributed to OHH providers that meet the excellent performance threshold. If all OHH providers satisfy the minimum performance threshold, then no amounts would be distributed to OHH providers who satisfy the excellent performance threshold. Performance calculations shall be based on the composite score of three performance measures, as set forth in the rule. Providers shall receive reports quarterly to inform them about whether they satisfied the minimum or excellent performance threshold standards, what their reimbursement shall be, as well as instructions for appeal if they disagree with the Department's determinations.
This rulemaking also makes the following changes:
• Clarifies that the clinical counselor provides behavioral health expertise and contributes to care planning, assessment of individual care needs, and identification of and connection to behavioral health services, as part of the services described in 93.05-1.
• Allows community health workers to be patient navigators, in response to requests from providers. A definition and certification/training requirements for community health workers is also added.
• Requires Connecticut Community for Addiction Recovery (CCAR) or other Department approved recovery coach training for recovery coaches. OHHs will have six months from rule adoption to train existing staff, and each new recovery coach will have six months to complete the applicable training upon start of delivery OHH services.
• Encourages people with lived experience to serve as recovery coaches but also allows recovery allies to serve as recovery coaches.
• Requires the OHH to adopt processes to identify and classify patients across their population served who are missing critical preventive services and/or other health screenings.
• Adds that members must be assessed for appropriateness of OHH services in alignment with American Society of Addiction Medicine guidelines.
• Requires OHHs to retain a signed consent form for all OHH members in the member record. The documentation must indicate that the individual has received information in writing, and verbally as appropriate, that explains the OHH purpose and the services provided and indicates that the individual has consented to receive the OHH services and understands their right to choose, change, or disenroll from their OHH provider at any time.
• Requires OHH providers to provide and document efforts to connect each OHH member to a primary care provider.
• Adds that health promotion activities may include health education and referral support for health-related risk factors (e.g. oral health, contraceptive counseling, preventive screenings).
• Removes language that referred to "coordinated case management" to align with language for the approved MaineCare SPA for these services, which instead utilizes an expanded team-based approach for the provision of additional supports, reimbursed through pass-through payments.
• Requires OHHs to conduct a comprehensive biopsychosocial assessment annually.
This rulemaking also consists of the following changes in ch. III section 93, “Opioid Health Home Services”:
The proposed rule introduces the Medication Plus and Methadone Levels of Care. The Medication Plus Level of Care reimburses for all OHH covered services except for OUD counseling, which allows members to receive OUD medication without electing to participate in OUD counseling. The Methadone Level of Care allows members who receive Methadone Medication Assisted Treatment (MAT) from Chapter II, Section 65, Behavioral Health Services, providers to receive Health Home services from the team-based care delivery model of the OHH.
Under the current rule, when members receiving OHH services elect to receive comprehensive care management and comprehensive transitional care from an additional support provider, the Department reimburses both providers separately. CMS advised that the OHH should reimburse the additional support provider via a pass-through payment. Hence, this rulemaking increases the reimbursement amount to the OHH provider to include a pass-through payment of $394.40 for the IOP, Induction, Stabilization, and Maintenance Levels of Care when members elect to receive services from an additional support provider.
In alignment with the Department's goal to implement value-based payment models tied to quality, the proposed rule adds a pay-for-performance provision that will withhold four (4) percent of OHH payments, pending the OHH's performance on three measures of OHH quality and effectiveness of service. The measures include assessing whether members in Maintenance and Stabilization Levels of Care have attended an annual primary care visit, had continuous pharmacotherapy as part of their MAT, and are involved in regular employment or other forms of community engagement. While the methodology for this pay-for-performance provision is detailed in rule, MaineCare will evaluate the need for adjustments to ensure OHH providers are not inappropriately penalized for the costs or changes in quality/utilization that result from COVID-19. Performance measure thresholds and the performance of other providers will determine if OHHs receive the full four percent and if they are eligible for a pay-for-performance surplus payment.
The proposed rules also make minor technical corrections.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
DATE, TIME AND PLACE OF PUBLIC HEARING: 1:00 p.m. Monday, April 4, 2022. Due to the ongoing threat posed by COVID-19, DHHS has determined that its public hearing will be conducted solely remotely, via Zoom. This is in accordance with the DHHS Remote Rulemaking Hearings Policy issued September 1O, 2021.
(link to Remote Hearings Policy: https://www.maine.gov/dhhs/sites/maine.gov.dhhs/files/inlinefiles/9%209%2021%20Remote%20Rulemaking%20Hearings%20Policy.pdf)
Zoom Meeting link: https://mainestate.zoom.us/j/82913607531
Meeting ID: 829 1360 7531
Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to participate in the hearing contact the person listed for this filing 5 days in advance of the hearing.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on April 14, 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 (if different): N/A
STATUTORY AUTHORITY: 22 MRS §§ 42, 3173
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: 18-125 - Department of Administrative and Financial Services (DAFS), Bureau of Revenue Services (Maine Revenue Services - MRS (Taxation))
CHAPTER NUMBER AND TITLE: Ch. 813, Property Tax Fairness Credit
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2022-P032
BRIEF SUMMARY:MRS is proposing to amend Rule 813 (“Property Tax Fairness Credit”) to reflect a recent law change that makes property tax payments made on behalf of a taxpayer by the State through the reinstated Elderly Tax Deferral Program to be eligible for the credit and to reflect that married taxpayers filing separately are not eligible for the credit.
PUBLIC HEARING: N/A
COMMENT DEADLINE: April 15, 2022
CONTACT PERSON FOR THIS FILING / SMALL BUSINESS IMPACT INFORMATION / MRS RULEMAKING LIAISON: Alex Weber, Office of General Counsel, Maine Revenue Services, 24 State House Station, Augusta, ME 04333-0024. Telephone: (207) 624-9712. Email: Alexander.J.Weber@Maine.gov.
FINANCIAL IMPACT ON MUNICIPALITIES OR COUNTIES: N/A
STATUTORY AUTHORITY FOR THIS RULE: 36 MRS §112
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different): N/A
MRS WEBSITE: www.maine.gov/revenue.
DAFS RULEMAKING LIAISON: Anya.Trundy@Maine.gov.

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: Section 999-3 (Charts):SNAP 224P, March 2022 Standard Utility Allowance Updates.
PROPOSED RULE NUMBER: 2022-P033
BRIEF SUMMARY: Each state agency is charged with determining standard utility allowances and having those approved by the United States Department of Agriculture (USDA).  Each year, Maine proposes figures based on the best available data in July for implementation in October. The utility allowance values for Federal Fiscal Year 2022 were calculated to increase using The Consumer Price Index (CPI) of 240.778% for June 2021 published by the Bureau of Labor Statistics of the Department of Labor, and were submitted to and approved by the USDA. Between June and October 2021, the CPI increased another 11.88 percentage points. This increase is indicative of an additional $2 per month in phone expenses, an additional $14 per month in utility expenses for households without a heating or cooling expense, and an additional $42 per month in utility expenses for households with a heating or cooling expense. To accurately reflect the expense of Maine families, the Department has submitted and the USDA has approved updated standard utility allowances for the remainder of Federal Fiscal Year 2022. These same changes were incorporated into the Supplemental Nutrition Assistance Program (SNAP) Rules, in emergency rule making number 2022-031. This rulemaking proposes to make those changes permanent to ensure that SNAP benefits are issued appropriately and accurately taking into account the high utility expenses experienced by Maine residents as verified by the Maine Public Utilities Commission1 and attested to by various media outlets 2.
1 maine.gov/tools/whatsnew/index.php?topic=puc-pressreleases&id=6112651&v=article088, and maine.gov/tools/whatsnew/index.php?topic=puc-pressreleases&id=6040934&v=article088
2 thedenverchannel.com/news/national/with-rising-heating-cost-more-people-are-expected-to-ask-for-assistance-with-bills-this-winter, pressherald.com/2021/11/09/mainers-to-face-double-digit-shock-in-electricity-supply-rates-next-year, and mainepublic.org/business-and-economy/2021-11-16/maine-utility-regulators-are-warning-electricity-customers-to-brace-for-a-big-rate-hike
See http://www.maine.gov/dhhs/ofi/rules/index.shtml for rules and related rulemaking documents.
PUBLIC HEARING:  None Scheduled
COMMENT DEADLINE: Tuesday, April 19, 2022, at 5:00 p.m. EDT. Written public comments may be submitted via the link at https://www.maine.gov/DHHS/OFI/about-us/rules/proposed.
CONTACT PERSON FOR THIS FILING: 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.
FINANCIAL IMPACT ON MUNICIPALITIES OR COUNTIES:  None anticipated.
STATUTORY AUTHORITY FOR THIS RULE: 22 MRS §§ 42(1), 3104
OFI RULES WEBSITE: http://www.maine.gov/dhhs/ofi/rules/index.shtml.
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: 65-407 – Maine Public Utilities Commission (MPUC)
CHAPTER NUMBER AND TITLE: Ch. 320, Electric Transmission and Distribution Utility Service Standards
TYPE OF RULE: Routine Technical
PROPOSED RULE NUMBER: 2022-P034
BRIEF SUMMARY: The Public Utilities Commission initiates a rulemaking proceeding to consider proposed amendments to the Commission’s Electric Transmission and Distribution Utility Service Standards Rule (ch. 320). The proposed amendments include substantial modifications intended to better measure and motivate improved performance in the areas of service quality and customer service, as well as for other aspects of the transmission and distribution (T&D) utilities’ performance.
PUBLIC HEARING: April 7, 2022 - 1:00 p.m. The Public Utilities Commission will conduct the hearing remotely via Microsoft Teams. Interested persons wishing to participate in the hearing by telephone may dial (207)-209-4724 and enter Conference ID 534 470 511#. Interested persons wishing to participate in the hearing using video may contact Margaret.Priest@Maine.gov for a link.
COMMENT DEADLINE: April 27, 2022. Written comments on the proposed rule may be filed until close of business on April 27, 2022. However, the Commission requests that initial comments be filed by March 31, 2022 to allow for follow up inquires during the hearing. Supplemental comments may be filed after the hearing. Written comments should refer to the docket number of this proceeding, Docket No. 2022-00052, and be filed using the Commission’s case management system (CMS) which is accessible from the Commission’s website.
CONTACT PERSON FOR THIS FILING / SMALL BUSINESS IMPACT INFORMATION: Nora Healy, Public Utilities Commission, 18 State House Station, Augusta, Maine 04333. Telephone: (207) 287-1384. Email: Nora.Healy@Maine.gov.
FINANCIAL IMPACT ON MUNICIPALITIES OR COUNTIES: Minimal fiscal impact.
STATUTORY AUTHORITY FOR THIS RULE: 35-A MRS §§ 104, 111, 2305-A, 3104-A, 3106, 3108
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different):
MPUC WEBSITE: www.maine.gov/mpuc.
MPUC RULEMAKING LIAISON: Jamie.A.Waterbury@Maine.gov.

ADOPTIONS

AGENCY: 10-144 - Department of Health and Human Services (DHHS), Maine Center for Disease Control and Prevention (Maine CDC)
CHAPTER NUMBER AND TITLE: Ch. 283, Newborn Bloodspot Screening Rule
TYPE OF RULE: Major Substantive
ADOPTED RULE NUMBER: 2022-037
CONCISE SUMMARY: Maine’s Newborn Bloodspot Screening Rule (10-144 CMR ch. 283) is a routine technical rule, except for Section 14 – “Fees”, which is a major substantive rule provision, pursuant to 5 MRS §8071(3)(B).
On March 11, 2021, the Department implemented Routine Technical and Major Substantive rule changes by emergency rulemaking. The subsequent adoption of Routine Technical rule changes effective June 1, 2021 permanently added four conditions to Maine’s newborn bloodspot screening panel. Major Substantive rule changes increasing the filter paper fee from $110 to $220 per infant tested were provisionally adopted May 24, 2021. The final adoption of this rule permanently implements the increase to the filter paper fee from $110 to $220 per infant tested, the major substantive portion of the rule. (5 MRS §8073.) The current emergency major substantive rule provision remains in effect up to 60 days after the legislative review and will expire when this final major substantive rule change becomes legally effective. (5 MRS §8072(8).)
EFFECTIVE DATE: April 13, 2022
MAINE CDC CONTACT PERSON: Bridget Bagley, Maine CDC, 286 Water Street - 11 State House Station, Augusta, ME, 04333-0011. Telephone: (207) 287-9394. Email: Bridget.Bagley@Maine.gov.
MAINE CDC RULES WEBSITE: http://www.maine.gov/dhhs/mecdc/rules/
MAINE CDC WEBSITE: https://www.maine.gov/dhhs/mecdc/.
MAINE CDC RULEMAKING LIAISON: Tera.Pare@Maine.gov.
DHHS WEBSITE: https://www.maine.gov/dhhs.
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov .

AGENCY: 01-015 - Department of Agriculture, Conservation and Forestry (DACF), Maine Milk Commission (MMC)
CHAPTER NUMBER AND TITLE: Ch. 29 (Repeal and replace), Dealer Margins
ADOPTED RULE NUMBER: 2022-038
CONCISE SUMMARY: The principal reason for this rulemaking is to update dealer margins. The margins adopted in this rule reflect the current cost of processing milk in Maine and will be used by the Maine Milk Commission in their monthly milk price setting meetings.
EFFECTIVE DATE: March 19, 2022
MMC CONTACT PERSON / RULEMAKING LIAISON: Julie-Marie Bickford, Maine Milk Commission – Agriculture, 28 State House Station, Augusta, ME 04333. Telephone: (207) 287-7521. Email: Julie-Marie.Bickford@Maine.gov.
MMC WEBSITE: https://www.maine.gov/dacf/milkcommission/index.shtml.

AGENCY: 16-633 – Department of Public Safety (DPS), Gambling Control Unit
CHAPTER NUMBER AND TITLE: Ch. 32, Rules Relating to Games of Chance
ADOPTED RULE NUMBER: 2022-039
CONCISE SUMMARY The rule package changes the distributor definition, distributor application and operational requirements, registration deadlines, electronic video machine certification, participants in games of chance and sealed tickets sales requirements
EFFECTIVE DATE: March 20, 2022
AGENCY CONTACT PERSON / RULEMAKING LIAISON: Milton Champion, Gambling Control Board and Unit, 45 Commerce Blvd. – 87 State House Station, Augusta Maine 04333. Telephone: (207) 626-3901. Email: Milton.F.Champion@Maine.gov.
WEBSITE: https://www.maine.gov/dps/gamb-control/index.html.