Proposed Rulemaking

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Chapter 101, Section 32, Chapter II, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders Word   
Concise Summary: The Department established Chapter II, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders in July of 2011. The Department decided to reopen Chapter II in response to comments to the initial proposed rule. The Department is proposing to add an Appendix I to Chapter II that would provide for an increased level of home support where certain criteria of need are met. The Department proposes to add definitions in Section 32.02 for the terms “Behavioral Interventions,” “Restraint” and “Seclusion.” The Department is proposing to add clarifying language to Section 32.03 regarding eligibility and priority. Additionally, the Department proposes to add language specifying the individual cost limits for waiver services, as set forth in the waiver application approved by the Centers for Medicare and Medicaid. Other technical changes and formatting are being proposed.
Submit Comments (Opens in new window) - Comment Deadline: March 8, 2012 Posted: February 8, 2012
 
MaineCare Benefits Manual, Chapter III, Section 50, Principles of Reimbursement for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) Services WORD  PDF 
Concise Summary: The Legislature amended 36 MRSA 2872, by increasing the tax on ICF-MRs from 5.5% to 6%, effective October 1, 2011. P.L. 2011, ch. 411. This rule proposes to change ICF MR reimbursement to allow reimbursement of the 6% tax, subject to CMS approval. This rule has a retroactive application with an effective date of October 1, 2011, which is authorized under 22 MRSA Sec. 42(8) because this rule amendment will benefit providers, by increasing their reimbursement.
Submit Comments (Opens in new window) - Comment Deadline: January 19, 2012 Posted: December 7, 2011
 
MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities WORD  PDF 
Concise Summary: This proposed rulemaking, if CMS approves, will raise the Cost of Living Adjustment (COLA) for Nursing Facilities to 2% beginning on October 1, 2011. This is prompted by changes to P.L. 2011, ch. 411. The retroactive application of this rule is permitted under 22 MRSA 42(8).
Submit Comments (Opens in new window) - Comment Deadline: December 16, 2011 Posted: November 15, 2011
 
MaineCare Benefits Manual, Chapter II, Section 9, Indian Health Service WORD  PDF 
Concise Summary: The proposed rule would consolidate and update all rules pertaining to reimbursement of Indian Health Service (IHS) clinic services to one new section of MaineCare Benefits Manual (MBM) policy in order to better serve the public and meet federal requirements by making requirements clearer. Some services provided by IHS providers are subject to different federal guidelines. Separation of these rules will clarify specific rules for IHS providers. The Department will also add guidelines for co-payment exemptions and tribal consultation, to be in compliance with new federal guidelines. Currently IHS services are included in MBM Section 3, Ambulatory Care Clinics. Section 3, Ambulatory Care Clinics will be amended at the same time as this rule-making to delete those portions that will now be part of Section 9, Indian Health Services.
Submit Comments (Opens in new window) - Comment Deadline: December 1, 2011 Posted: October 7, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 3, Ambulatory Care Clinic Services WORD  PDF 
Concise Summary: The proposed rule would consolidate and update all rules pertaining to reimbursement of Indian Health Service (IHS) clinic services to one new section of MaineCare Benefits Manual (MBM) policy in order to better serve the public and meet federal requirements by making requirements clearer. Some services provided by IHS providers are subject to different federal guidelines. Separation of these rules will clarify specific rules for IHS providers. The Department will also add guidelines for co-payment exemptions and tribal consultation, to be in compliance with new federal guidelines. Currently IHS services are included in MBM Section 3, Ambulatory Care Clinics. Section 3, Ambulatory Care Clinics will be amended at the same time as this rule-making to delete those portions that will now be part of Section 9, Indian Health Services.
Submit Comments (Opens in new window) - Comment Deadline: December 1, 2011 Posted: October 7, 2011
 
MaineCare Benefits Manual, Chapters II and III, Section 13, Targeted Case Management Services WORD  PDF 
Concise Summary: This rulemaking proposes elimination of two target groups currently being reimbursed under Chapter 13, Targeted Case Management (TCM); “Case Management Services for Children Involved with Protective Services”, and “Case Management Services for Adults Involved with Protective Services”. Additionally the rulemaking proposes additional medical eligibility criteria for the target group “Members Experiencing Homelessness”. Chapter II is also changed to; delete obsolete language concerning the 2009 transition to one Comprehensive Case Manager, clarify supervision of comprehensive case managers, eliminate some professional staff categories, clarify qualifications for social workers and add a requirement for documentation that members have had choice of providers. Chapter III is changed to align the standard units of service and maximum allowance for two categories of TCM services with the other TCM categories.
Submit Comments (Opens in new window) - Comment Deadline: September 1, 2011 Posted: August 2, 2011
 
MaineCare Benefits Manual, Section 32, Chapter III, Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders-Major Substantive Rule WORD  PDF 
Concise Summary: The Department is creating a new Section of the MaineCare Benefits Manual that will be known as Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders. These Services are provided to children through a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services (CMS). Chapter III establishes billing procedure codes based on HIPAA compliant CPT coding. Services will be provided to children with Intellectual Disabilities or Pervasive Developmental Disorders to support them to live in the community rather than in institutional settings. This major substantive rule is a companion to a routine technical rule proposing to establish the rules for delivering these services in MaineCare Benefits Manual Ch. II, Section 32. These rules were adopted on an emergency basis effective July 1, 2011.
Submit Comments (Opens in new window) - Comment Deadline: August 25, 2011 Posted: July 25, 2011
 
MaineCare Benefits Manual, Section 32, Chapter II, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF 
Concise Summary: The Department is creating a new Section of the MaineCare Benefits Manual that will be known as Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders. These Services will be provided to children through a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services (CMS). Services in Chapter II include Home Support, Home Accessibility Adaptations, Transportation, Consultation, Communication Aids and Respite Care. Services will be provided to children with Intellectual Disabilities or Pervasive Developmental Disorders to support them to live in the community rather than in institutional settings. This routine technical rule is a companion to a major substantive rule proposing to establish rates for services in MaineCare Benefits Manual Ch. III, Section 32. These rules were adopted on an emergency basis effective July 1, 2011.
Submit Comments (Opens in new window) - Comment Deadline: August 25, 2011 Posted: July 25, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 109, Speech and Hearing Services WORD  PDF 
Concise Summary: The Department of Health and Human Services is proposing this rule to remove any differing requirements for school based providers, and require them to meet all other requirements of comparable community based providers. In addition, the Department will clarify that medical necessity for these services requires appropriate documentation, and that provision of services must be documented. Each member’s written progress note must now contain the start and stop time of the service provided to the MaineCare member. Additionally, the proposed Chapter III contains multiple corrected units of service to HIPAA compliant coding in preparation for MIHMS certification, adds billing modifiers, and removes one redundant billing code S9152 Speech therapy, re-evaluation. The Department proposes necessary rate adjustments to remain cost neutral with the corrected units of service. Procedure codes 92526, 92550, 92565, 92568, 92610, V5364, V5364 TF are added in this proposed rule and will be reimbursed retroactively to 09/01/2010. This proposed rule also clarifies how some of the HIPAA compliant billing codes are state-level defined and applied and adds three new billing modifiers.
Submit Comments (Opens in new window) - Comment Deadline: August 18, 2011 Posted: July 14, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 85, Physical Therapy Services WORD  PDF 
Concise Summary: This proposed rule will remove any differing requirements for school based providers, and require them to meet all other requirements of comparable community based providers. In addition the Department clarifies that pursuant to 42 CFR 440.110, MaineCare physical therapy services must be prescribed by a physician or other licensed practitioner of the healing arts within the scope of practice under Maine law and must be provided by or under the direction of a qualified licensed physical therapist. Medical necessity for and the provision of these services to MaineCare members requires appropriate documentation. Each member’s written progress note must contain the start and stop time of the service. In Chapter III of this Section, billing modifiers TL and TM will be required for all services that are delivered under a Maine Department of Education Individualized Family Service Plan (IFSP) or an Individualized Education Plan (IEP), respectively.
Submit Comments (Opens in new window) - Comment Deadline: August 18, 2011 Posted: July 14, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 68, Occupational Therapy Services WORD  PDF 
Concise Summary: This proposed rule will remove any differing requirements for school based providers, and require them to meet all other requirements of comparable community based providers. In addition the Department clarifies that pursuant to 42 CFR 440.110, MaineCare occupational therapy services must be prescribed by a physician or other licensed practitioner of the healing arts within the scope of practice under Maine law and must be provided by or under the direction of a qualified licensed occupational therapist. Medical necessity for and the provision of these services to MaineCare members requires appropriate documentation. Each member’s written progress note must contain the start and stop time of the service. The Department is correcting that adult members are responsible for copayments up to $20 per month for Occupational Services. In Chapter III of this Section, billing modifiers TL and TM will be required for all services that are delivered under a Maine Department of Education Individualized Family Service Plan (IFSP) or an Individualized Education Plan (IEP), respectively.
Submit Comments (Opens in new window) - Comment Deadline: August 18, 2011 Posted: July 14, 2011
 
MaineCare Benefits Manual, Chapter II, Section 60, Medical Supplies WORD  PDF 
Concise Summary: The proposed rule amends language to indicate that a provider may bill for up to a 72 day supply of incontinence supplies. The websites listed in this rule have been updated. In addition, several prior authorization criteria have been removed and providers are now directed to visit the MIHMS provider portal for information regarding prior authorizations and to locate criteria utilized by the Department. The reimbursement methodology has been revised for miscellaneous Medical Supplies and Durable Medical Equipment. A new requirement has been added to indicate that a face-to-face encounter is required during the 6 months preceding the physician’s written order for durable medical equipment. This is a mandatory provision of the Patient Protection and Affordable Care Act, PL 111-148 § 6407.
Submit Comments (Opens in new window) - Comment Deadline: June 30, 2011 Posted: May 27, 2011
 
MaineCare Benefits Manual, Chapter II, Section 21 Home and Community Benefits for Adults with Mental Retardation or Autistic Disorder Word   
Concise Summary: The Department proposes replacing the term “mental retardation” with “intellectual disabilities” where appropriate, to conform to more modern terminology. This is consistent with the newest revision to the Diagnostic and Statistical Manual and the Department’s focus on respectful language. Also, the Department proposes to rename the initial classification process to “Determination of Eligibility.” Provisions regarding owned-operated businesses in the employment setting are clarified. Furthermore, the Department proposes to reduce the maximum allowance for community support service hours and work support service hours. The Department also proposes clarification language around work support services provided by a Direct Support Professional (DSP) to one member at a time. The Department establishes two additional grounds for involuntary termination of services to a member. Qualifications for DSPs and Employment Specialists are amended in this proposed rule-making. The proposed rules specify the use of the appeals process for members outlined in Chapter I of the MaineCare Benefits Manual. Finally, the rule includes a new Appendix IV, which outlines the various combinations of community support and work support hours available. The proposed changes conform the regulation to amendments contained in the waiver renewal application recently submitted to CMS.
Submit Comments (Opens in new window) - Comment Deadline: 2010-06-17 Posted: May 13, 2010
 

 

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