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Home > Weekly Rule-making Notices > January 8, 2014

January 8, 2014

WEEKLY NOTICES OF STATE RULE-MAKING
Public Input for Proposed and Adopted Rules

Notices are published each Wednesday to alert the public regarding state agency rule-making. 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 rule-making if the petition is signed by 150 or more registered voters, and may begin rule-making 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 rule-making liaisons, who are single points of contact for each agency.


NOTICE


AGENCY: 29-250 - Department of Secretary of State, Bureau of Corporations, Elections & Commissions
RULE TITLE OR SUBJECT: Request for Comments on the Maine Administrative Procedure Act
CONCISE SUMMARY: By the end of January, 2014, the Secretary of State must file an annual report to the Governor and the Joint Standing Committee on State and Local Government on the Administrative Procedure Act. The purpose of this ad is to solicit, from state agencies and the public, recommendations for improvements to the rule-making process. We will include any comments on these recommended improvements in the report.
STATUTORY AUTHORITY: 5 MRSA §8056-A
PUBLIC HEARING: None
DEADLINE FOR COMMENTS: January 28, 2014
AGENCY CONTACT PERSON: Don Wismer, APA Coordinator, Department of Secretary of State, 101 State House Station, Augusta, ME 04333. Telephone: (207) 624-7650. Fax: (207) 287-6545. E-mail: Don.Wismer@Maine.gov .
WEBSITE: http://www.maine.gov/sos/cec/rules/index.html .


PROPOSALS


No proposals this week.


ADOPTIONS


AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS)
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual: Ch. X Section 2, Non-Categorical Adults
ADOPTED RULE NUMBER: 2013-332 (Repeal)
CONCISE SUMMARY: The MaineCare Childless Adults section 1115 demonstration waiver that provided health care coverage to childless adults and non-custodial parents with incomes at or below 100% of the Federal Poverty Level (FPL), expires on December 31, 2013. Therefore, the Department is repealing Ch. X Section 2, Non-Categorical Adults. This population of adults will no longer be eligible for MaineCare benefits as of December 31, 2013.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rule-making documents.
EFFECTIVE DATE: January 1, 2014
AGENCY CONTACT PERSON: Cari Bernier, Comprehensive Health Planner II, MaineCare Services, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4031. Fax: (207) 287-1864. TTY: 711 (Deaf or Hard of Hearing). E-mail: Cari.Bernier@Maine.gov
WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULE-MAKING LIAISON: Kevin.Wells@Maine.gov .



AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS)
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual: Ch. II Section 68, Occupational Therapy Services
ADOPTED RULE NUMBER: 2013-333
CONCISE SUMMARY: The Department is adopting changes to this rule to require prior authorization for all Occupational Therapy Services for persons age 21 and older. The Department is also adopting the following changes:
a. Adding a definition for Long-Term Chronic Pain and Terminal Illness;
b. Adding new covered services and clarifying covered services and their limits;
c. Limiting supplies to splinting only and adding the link to the Department’s Rate Setting website; and,
d. Adding language and clerical changes to clarify the policy.
Additionally, changes to the final rule include:
a. Language regarding the intent of requiring prior authorization on all services before payment was removed from section 68.07-3 for clarification, as recommended by the Attorney General’s office; and,
b. Due to comments 1-2, and 4-10, section 68.07-2 was changed to remove language requiring services to be ordered by a physician.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rule-making documents.
EFFECTIVE DATE: January 1, 2014
AGENCY CONTACT PERSON: Cari Bernier, Health Planner, Division of Policy , 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4031. Fax: (207) 287-1864. TTY: 711 (Deaf/Hard of Hearing). E-mail: Cari.Bernier@Maine.gov .
WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULE-MAKING LIAISON: Kevin.Wells@Maine.gov .



10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS)
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual: Ch. II Section 85, Physical Therapy Services
ADOPTED RULE NUMBER: 2013-334
CONCISE SUMMARY: The Department is adopting changes to this rule to require prior authorization for all Physical Therapy Services for persons age 21 and older. The Department is also adopting the following changes:
a. Adding a definition for Long-Term Chronic Pain and Terminal Illness;
b. Adding new covered services and clarifying covered services and their limits;
c. Limiting supplies to splinting only and adding the link to the Department’s Rate Setting website; and,
d. Adding language and clerical changes to clarify the policy.
Additionally, changes to the final rule include:
a. Language regarding the intent of requiring prior authorization on all services before payment was removed from section 85.07-3 for clarification, as recommended by the Attorney General’s office; and
b. Due to comments 1-2, 4-6, and 8-9, section 85.07-2 was changed to remove language requiring services to be ordered by a physician.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rule-making documents.
EFFECTIVE DATE: January 1, 2014
AGENCY CONTACT PERSON: Cari Bernier, Health Planner, Division of Policy , 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4031. Fax: (207) 287-1864. TTY: 711 (Deaf/Hard of Hearing). E-mail: Cari.Bernier@Maine.gov .
WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULE-MAKING LIAISON: Kevin.Wells@Maine.gov .



AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS)
CHAPTER NUMBER AND TITLE: Ch. 101, MaineCare Benefits Manual: Ch. I Section 1, General Administrative Policies and Procedures
ADOPTED RULE NUMBER: 2013-335
CONCISE SUMMARY: The adopted rule amends several sections of Ch. 101, MaineCare Benefits Manual, Ch. I Section 1, “General Administrative Policies and Procedures”. The Department is adopting the following changes to the rule, for the following reasons:
1. Removed references to DirigoChoice, since the Maine Legislature dissolved the Dirigo Health Agency (P.L. 2013, ch. 368, Sec. A-19).
2. As required by 45 C.F.R. 162.410, any MaineCare provider that is a "covered health care provider" must obtain a National Provider Identifier (NPI).
3. Requires that MaineCare providers must include their NPI on their MaineCare Provider Agreements and MaineCare enrollment applications, and requires updates for new or changed NPIs.
4. Requires that all MaineCare providers must include their NPI on all MaineCare claims, pursuant to the Affordable Care Act, Section 6402(a), as codified in 42 CFR 431.107, or those claims will be denied.
5. Pursuant to 42 CFR 455.410, specifies that, in order for MaineCare to reimburse for services or medical supplies or prescriptions resulting from a provider's order, prescription or referral, the ordering, prescribing or referring (OPR) provider must be enrolled in MaineCare, and the OPR provider's NPI must be on the claim. This change will be effective when the Maine Medicaid Management Information System (MMIS) is able to process this change, and the Department will notify all providers via the listserve, and also serve notice to the Secretary of State's office, as required by 5 MRSA §8052(6).
6. Pursuant to P.L. 2013, c. 368, Part A-34, effective January 1, 2014, if approved by CMS, the Department will limit cost sharing payments for the Qualified Medicare Beneficiary without other Medicaid (QMB only) population to hospital and nursing facility providers, to the amount necessary to provide a total payment equal to the amount MaineCare would pay for these services under the State Plan. The Department is seeking CMS approval to amend its State Plan for this change. The Department will serve notice to all providers via the listserve, and also notify the Secretary of State's office upon CMS approval, pursuant to 5 MRSA §8052(6).
7. The Department makes some additional changes to Section 1.07-5 (Medicare provision), all to comport with the current State Plan, and these changes also reflect the Department's current practice: (a) adding hospitals and nursing facilities to the list of Maine Care providers who may bill MaineCare for cost sharing (however, the cost sharing is limited in that it cannot exceed the lowest rate that Medicare determines to be the allowed amount); (b) deleting references to "Medicare Part B" in provisions where the provisions related both to Medicare A and B, pursuant to the State Plan; (c) deleting a provision regarding claims received from January 1, 1997 to February 29, 2000, since that time period has long passed.
8. As a result of public comments regarding the proposed rule, and pursuant to 42 D.S.C. § 1396a(n)(3), added subpart (E) to Section 1.07-5, which strictly prohibits providers from seeking to collect any amount from a QMB for Medicare deductibles or coinsurance, even if the MaineCare payment is less than the total amount of the Medicare deductible and coinsurance.
Providers are, however, allowed to collect from the QMB Member any MaineCare copayrnent for the service.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rule-making documents.
EFFECTIVE DATE: January 1, 2014
AGENCY CONTACT PERSON: Michael J. Dostie, Comprehensive Health Planner II, Division of Policy, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4035. Fax: (207) 287-9369. TTY: 711 (Deaf / Hard of Hearing). E-mail: Michael.Dostie@Maine.gov .
WEBSITE: http://www.maine.gov/dhhs/oms/ .
DHHS RULE-MAKING LIAISON: Kevin.Wells@Maine.gov .



?AGENCY: 94-457 - Finance Authority of Maine (FAME)
CHAPTER NUMBER AND TITLE: Ch. 610, Educators for Maine Program
ADOPTED RULE NUMBER: 2013-336
CONCISE SUMMARY: The rule, as amended, will provide benefits to Maine residents employed as qualified Jobs for Maine's Graduates specialists by allowing them to obtain loan forgiveness. Increased availability of loan forgiveness to some borrowers may reduce overall availability of program funds to other borrowers, but the amendment is not expected to cause any increased costs to the State of Maine.
EFFECTIVE DATE: January 5, 2014
AGENCY CONTACT PERSON: Katryn Gabrielson, Finance Authority of Maine, 5 Community Drive, Augusta, ME 04332. Telephone: (207) 620-3515. E-mail: kgabrieIson@famemaine.com .
WEBSITE: http://www.famemaine.com .
FAME RULE-MAKING LIAISON: croney@famemaine.com .



AGENCY: 10-144 - Department of Health and Human Services (DHHS), Office for Family Independence (OFI)
CHAPTER NUMBER AND TITLE: Ch. 332, MaineCare Eligibility Manual, Rule #273E: Implementation of MAGI Eligibility Methodology:
Parts 1 (General Information),
PART 2 (Basic Eligibility Criteria),
PART 3 (Categorically Needy Families with Children-related Coverage),
PART 3.5 (Eligibility Group Requirements),
PART 4 (Family-Related Budgeting),
PART 4.5 (Budgeting for Eligibility Groups for which MAGI-Based Methodology Applies),
PART 5 (Children's Health Insurance Program (CHIP) - Cub Care),
PART 5.5 (Children's Health Insurance Program (CHIP) - Cub Care),
PART, 16 (Assets),
PART 16.5 (Assets),
PART 17 (Income),
PART 17.5 (Income),
CHART 6.5 (Federal Poverty Level/MAGI 5% Reduction Calculation/Effective January 1, 2013)
CHART 8.5; (Cub Care)
ADOPTED RULE NUMBER: 2013-337 (Emergency)
CONCISE SUMMARY: Effective January 1, 2014, these emergency rules will implement the provisions of the Affordable Care Act related to MAGI Medicaid and CHIP eligibility. MaineCare will determine most non-elderly, non-disabled Medicaid and all CHIP eligibility by comparing the Modified Adjusted Gross Income (MAGI) income (based on the Internal Revenue Code, Section 36B) to the applicable income eligibility standard.
However, application of the MAGI financial eligibility methodologies will not be applied under two circumstances:
A. For individuals who are MaineCare beneficiaries as of December 31, 2013, application of the MAGI financial eligibility methodologies will not be applied until March 31, 2014 or the next regularly scheduled renewal of eligibility determinations, whichever is later, as follows: (1) if the Member's renewal date is between January 1 and March 31, 2014, the Department will first apply the MAGI eligibility rule. If the Member is not eligible under the MAGI rule, the Department will apply the non-MAGI eligibility rule. On April 1, 2014, the Department will re-determine MaineCare eligibility, using only the MAGI rule. (2) if the Member's renewal date is between April 1 and December 31, 2014, for purposes of determining MaineCare eligibility for changes-in-circumstances, the Department will first apply the MAGI rule. If the Member is ineligible under the MAGI rule, the Department will apply the non-MAGI eligibility rule. On the Member's renewal date, the Department will apply the MAGI rule.
B. For individuals who are requesting retroactive Medicaid coverage for months prior to January 1, 2014, the Department will apply the non-MAGI eligibility rule.
In this rule-making, the Department made changes to the following MaineCare Eligibility regulations in order to comply with MAGI: PARTS 1, 2, 3, 4, 5, 16 and 17. The Department adopted the following new MaineCare MAGI eligibility regulations: PARTS 3.5, 4.5, 5.5, 16.5, and 17.5, CHARTS 6.5 and 8.5.
EFFECTIVE DATE: December 31, 2013
AGENCY CONTACT PERSON: R. W. Bansmer, Jr., MaineCare Senior Program Manager, Department of Health and Human Services, Office for Family Independence, 11 State House Station, 19 Union Street, Augusta ME 04333-0011. Telephone: (207) 624-4105. TTY: 711 (Maine Relay). E-mail: Reinhold.Bansmer@Maine.gov .
WEBSITE: http://www.maine.gov/dhhs/ofi/ .
DHHS RULE-MAKING LIAISON: Kevin.Wells@Maine.gov .