Emergency Rulemaking

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MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities Word  PDF   
Concise Summary: In this emergency rulemaking, the Department adopts the changes required by Resolve 2013, ch. 72 (LD 1189), to clarify the timeframe during which nursing facilities must demonstrate their compliance with the October 1, 2011 2% cost-of-living adjustment (COLA) for front line staff. If CMS approves, the following applies for the 2% October 2011 COLA that the Department gave to nursing facilities: nursing facilities must demonstrate, to the satisfaction of the Department, a 2% increase in the average wage and benefit rate per hour for front line employees for their first fiscal years ending after July 1, 2013, from the average wage and benefit rate per hour for front line employees that was in effect for their fiscal years ending 2008. If the nursing facilities cannot demonstrate that 2% increase to the satisfaction of the Department, then the Department will recoup, at time of audit, the difference between what the average wage and benefit rate per hour for front line employees for the first fiscal years ending after July 1, 2013 should have been if it had been increased by 2% from what it was. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: February 28, 2014
 
MaineCare Benefits Manual, Chapter II, Section 13, Targeted Case Management  
Concise Summary: CONCISE SUMMARY: This emergency rule updates the Targeted Case Management (TCM) policy to include the Child and Adolescent Needs and Strength (CANS) assessment as an approved TCM eligibility tool. The Department will no longer fund the Child and Adolescent Functional Assessment Scales (CAFAS) as of January 31, 2014 and must have the CANS in place to assure that providers who cannot self fund the CAFAS have an approved tool to evaluate members for TCM eligibility. Without the immediate implementation of these changes, MaineCare members' access to medically necessary services is at risk. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: December 20, 2013
 
MaineCare Benefits Manual, Ch 101, Sec 45, Ch III, Hospital Services PDF   
Concise Summary: CONCISE SUMMARY: This emergency rule increases the MaineCare hospital supplemental pool to $65.321 million, because the Legislature appropriated an additional $10.472 million. P.L. 2013, ch. 368, PART A, Sec. A-34. The Department is seeking approval from the Centers for Medicare and Medicaid Services, to amend its State plan related to hospital reimbursement, for this change.
Effective Date: November 15, 2013
 
MaineCare Benifits Ch 101, Ch II, Sec 67, Nursing Facility Services PDF   
Concise Summary: CONCISE SUMMARY: This proposed rulemaking seeks to permanently adopt changes already made on an emergency basis, implementation of budget initiative of P.L. 2013, ch. 368, as amended by P.L. 2013, ch. 423. This rulemaking will, retroactive to April 1, 2013, increase the number of days that MaineCare will reimburse a nursing facility for: (a) Therapeutic Leave of Absence from one (1) day to twenty (20) days per state fiscal year, and (b) Bed Hold Days from four (4) per year to seven (7) per inpatient hospitalization. The rulemaking also makes the following clerical changes: (1) inserts the word “Therapeutic” before “Leave Days for a MaineCare Member” on page 39, (2) changes that entry in the Table of Contents so that it conforms to the language on page 39. The Department is seeking approval from the Centers for Medicare and Medicaid Services for a state plan amendment for this change.
Effective Date: 08-27-2013
 
MaineCare Benifits Manual,Ch II, Sec 45, Hospital Services PDF   
Concise Summary: CONCISE SUMMARY: This emergency rulemaking, effective August 27, 2013, retroactive to April 1, 2013 seeks to implement a provision in the 2014-15 budget law (P.L. 2013, ch. 368), as amended by P.L. 2013, ch. 423. Specifically, this rulemaking will increase the number of days that MaineCare will reimburse a hospital for therapeutic Leave of Absence- During Days Awaiting Nursing Facility Placement from one (1) day to twenty (20) days per state fiscal year.
Effective Date: 08-27-2013
 
MaineCare Benefits Manual, Ch 104, Sec 4 Maine Part D Wrap Benefits Word   
Concise Summary: CONCISE SUMMARY: The emergency rule will eliminate Medicare Part D prescription drug copayments for Medicare Savings Program members who are not also eligible for and receiving the full MaineCare benefit. This change is being made pursuant to PL 2013, Chapter 368, Part A, Section A-34, and Part UU, Section UU-1, of the State of Maine Biennial Budget.
Effective Date: August 09, 2013
 
MaineCare Benefits Manual, Ch III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder--EMERGENCY MAJOR SUBSTANTIVE RULE word  pdf   
Concise Summary: The Department of Health and Human Services is adopting an Emergency Major Substantive Rule to delete the reimbursement codes for transportation, since transportation for Section 21 services will be provided and reimbursed only through Section 113, effective on August 1, 2013, the date that the Department is implementing its Section 113 Transportation Services Waiver. The Section 113 Transportation Waiver, approved by the Centers for Medicare & Medicaid Services (CMS) on April 23, 2013, provides all Non-Emergency Transportation (NET) for all MaineCare members, including transportation for Section 21 Waiver services. On October 2, 2012, CMS approved an amendment to the Section 21 Waiver (the "Section 21 Waiver"), limiting Section 21 members’ transportation choice to require them to utilize transportation only under the Section 113 Transportation Waiver. In addition, the Section 21 Waiver added Board Certified Behavioral Analysts (BCBAs) as qualified providers for consultation with eligible members. As such, this emergency rule deletes the reimbursement codes for transportation, since transportation for Section 21 services will be provided and reimbursed only through Section 113, effective on August 1, 2013. Providers may no longer be reimbursed for transportation services under Section 21. Through this emergency rule, the Department is also adding a HCPCS procedure code for Behavioral Consultation, G9007 HI which will be $14.85 per fifteen minute unit.
Effective Date: August 1, 2013
 
MaineCare Benefits Manual, Ch III, Sec 32, Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF   
Concise Summary: The Department of Health and Human Services is adopting an Emergency Major Substantive Rule to delete the reimbursement codes for transportation, since transportation for Section 32 services will be provided and reimbursed only through Section 113, effective on August 1, 2013, the date that the Department is implementing its Section 113 Transportation services waiver. The Section 113 transportation waiver, approved by the Centers for Medicare & Medicaid Services (CMS) on April 23, 2013, provides all Non-Emergency Transportation (NET) for all MaineCare members, including transportation for Section 32 waiver services. On October 2, 2012, CMS approved an amendment to the Section 32 waiver, limiting Section 32 members’ transportation choice to require them to utilize transportation only under the Section 113 transportation waiver. This emergency rule deletes the reimbursement codes for transportation, since transportation for Section 32 services will be provided and reimbursed only through Section 113, effective on August 1, 2013. Providers may no longer be reimbursed for transportation services under Section 32.
Effective Date: August 1, 2013
 
MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder Word  PDF   
Concise Summary: The Department of Health and Human Services is adopting an Emergency Major Substantive Rule to delete the reimbursement codes for transportation, since transportation for Section 29 services will be provided and reimbursed only through Section 113, effective on August 1, 2013, the date that the Department is implementing its Section 113 Transportation services waiver. The Section 113 transportation waiver, approved by the Centers for Medicare & Medicaid Services (CMS) on April 23, 2013, provides all Non-Emergency Transportation (NET) for all MaineCare members, including transportation for Section 29 waiver services. On October 2, 2012, CMS approved an amendment to the Section 29 waiver, limiting Section 29 members’ transportation choice to require them to utilize transportation only under the Section 113 transportation waiver. This emergency rule deletes the reimbursement codes for transportation, since transportation for Section 29 services will be provided and reimbursed only through Section 113, effective on August 1, 2013. Providers may no longer be reimbursed for transportation services under Section 29.
Effective Date: August 1, 2013
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services word  pdf   
Concise Summary: This emergency rulemaking seeks to implement a budget initiative of LD 250, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Year Ending June 30, 2013. This rule allows reimbursement for a distinct substance abuse unit discharge rate for acute care non-critical access hospitals who meet the standard. The rate is $4,898 per stay. The Department is seeking CMS approval of the state plan for this change.
Effective Date: April 1, 2013
 
MaineCare Benefits Manual, Ch. VI, Sec. 1, Primary Care Case Management word  pdf   
Concise Summary: The Department is repealing the Patient Centered Medical Home provision of the Primary Care Case Management (PCCM) rule, MaineCare Benefits Manual, Ch. VI, Sec. 1, effective January 1, 2013, through emergency rulemaking, because this service will be offered, effective January 1, 2013, in the MaineCare Benefits Manual, Ch. II, Sec. 91 and Ch. III, Sec. 91 (Health Home Services), also through emergency rulemaking. The State will receive an enhanced federal match of 90% for the Section 91 services, which will save the state money. The DHHS will be seeking Centers for Medicaid and Medicare Services (CMS) approval of the State Plan for these changes, and this rule will become effective upon CMS approval.
 
MaineCare Benefits Manual, Chapters II & III, Section 91, Health Home Services word  pdf   
Concise Summary: Effective January 1, 2013, the Department will offer and reimburse Health Home Services under a new section of policy, Chapters II and III, Section 91. Health Home Practices will be reimbursed at a rate of $12.00 per member per month and Community Care Teams will be reimbursed at a rate of $129.50 per member per month under this section of policy, if they meet the standards of Section 91. This new MaineCare service will be offered to eligible MaineCare members who have been diagnosed with two chronic conditions, or who have one chronic condition and are at risk for another chronic condition. Under a Plan of Care, members will receive all or some of the following services: Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care, Individual and Family Support Services, and Referral to Community and Social Support Services. These services are unique and will not duplicate other MaineCare services. The DHHS will be seeking CMS approval of the State Plan for these changes.
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapter II, Section 85, Physical Therapy Services word  pdf   
Concise Summary: This emergency rule is being adopted in accordance with PL 2011, ch. 657, Part O. The changes made in this rule allow more Physical Therapy services, up to five (5) treatment visits and one (1) evaluation within twelve (12) months, when provided pursuant to a pain management care plan as described in the MaineCare Benefits Manual Section 80.07-5(D)(3).
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services word  pdf   
Concise Summary: The Department of Health and Human Services (DHHS) has adopted an emergency rule to impose limits on opioid medications used for the treatment of pain, PL 2011, ch. 657, Part O and section L-1. This emergency rule includes definitions of acute and non-acute pain, establishes certain exclusions as described in the legislation, mandates the use of a pain management care plan when a member requires the extended use of opioid medications for the treatment of pain and identifies therapeutic treatment options that must be utilized for members who are prescribed opioid medications to treat non-acute pain.
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapter II, Section 65, Behavioral Health Services word  pdf   
Concise Summary: This emergency rule is adopted in accordance with PL 2011, ch. 657, Section S-1, and will limit MaineCare reimbursement for methadone treatment of addiction to opioids to a maximum of twenty four (24) months per lifetime, except as permitted with prior authorization beyond twenty-four (24) months. Only treatment after the effective date of this rule (January 1, 2013) will count toward the limit.
Effective Date: January 1, 2013
 
MaineCare Benefits Manual, Chapters II and III, Section 65, Behavioral Health Services WORD  PDF   
Concise Summary: On May 16, 2012, the Department of Health and Human Services (DHHS) proposed rulemaking for Chapters II and III, Section 65, Behavioral Health Services, proposing to require providers to: (1) employ or contract a Medical Director; and (2) change several HCPC codes to CPT codes. The Department received a significant number of comments from various providers and advocates across the state emphasizing the considerable administrative burden this rulemaking would cause for their agencies. After considering the comments, the Department has decided not to adopt these provisions of the proposed rule. In order to comply with section M-1 of the 1st Supplemental Budget P.L. 2011, ch. 477, Parts M-1 and EE-1, the Department is adopting this emergency rule that will continue a rule provision previously adopted via emergency on April 1, 2012 and proposed on May 16, 2012 that reduced the weekly rate for Opioid Treatment (Methadone) from $72.00 to $60.00 per week. The Department is adopting a second emergency rule because portions of the first emergency rule, effective April 1, 2012, need to be retained, while other parts can be proposed through routine rulemaking. Through this emergency rule, the Department is eliminating language indicating that “Only Mental Health Agencies who are also Private Special Purpose Schools are allowed to provide Children’s Behavioral Health Day Treatment.” The elimination of this language will allow other types of providers to provide Children’s Behavioral Health Day Treatment. The Department is also requesting to revise the modifiers and rates for codes H2021-Comprehensive Community Support Services-Functional Family Therapy and G9007-Collateral Services-Functional Family Therapy in order to assure that providers can bill and are paid appropriately for services rendered. This change is a benefit to the providers.
Effective Date: June 29, 2012
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services WORD  PDF   
Concise Summary: This emergency rulemaking seeks to implement the use of the Ambulatory Payment Classification (APC) system-based reimbursement for almost all outpatient services, including lab and radiology, for private Non-Critical Access and rehabilitation hospitals, effective July 1. Maine is adopting Medicare methodology and will pay 93% of the Medicare rate. These hospitals will no longer receive any Prospective Interim Payments (PIP). Non-state, public, Non-Critical Access hospitals will still be paid on a percentage of cost basis and will receive an outpatient PIP. Reflecting these changes, the general description of the types of hospitals in Maine and the related reimbursement methodologies will change. Critical Access Hospitals would be exempted from the requirements to count readmissions within 72 hours as part of the initial discharge. The DHHS will be seeking CMS approval of the State Plan for these changes.
Effective Date: July 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder Word  PDF   
Concise Summary: This Emergency Major Substantive Rule adopts a 5% decrease in rates for Agency Home Support per diem as directed by P.L. 2011, Chapter 477, M-1. This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: July 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services WORD  PDF   
Concise Summary: The emergency adopted rule specifies that the weekly rate for Opioid Treatment (Methadone) is reduced from $72.00 to $60.00 per week.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services WORD  PDF   
Concise Summary: This emergency rule is being adopted pursuant to Public Law, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012, which directed the Department to reduce reimbursement of Adult Family Care Services by 10%. This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: April 1, 2012
 

 

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