CONCISE SUMMARY: This emergency rulemaking institutes measures, effective immediately, to expedite and improve access to medical care for MaineCare members due to the 2019 Novel Coronavirus (COVID-19). Pursuant to 5 MRS §§ 8054 and 8073, the Department has determined that immediate adoption of this rule is necessary to avoid a potentially severe and immediate threat to public health, safety or general welfare. The Department's findings of emergency are included in detail in the Emergency Basis Statement. Maine is facing a substantial public health threat posed by the global spread of COVID-19. On March 11, 2020 the World Health Organization declared COVID-19 a worldwide pandemic. On March 15, 2020, Governor Janet T. Mills declared a state of civil emergency in Maine.
This is a single new section of the MaineCare Benefits Manual that implements emergency changes for multiple types of MaineCare services. The following sections of MaineCare policy are affected by this rulemaking: Ch. 1 Section 1 (General Administrative Policies and Procedures); Ch. I Section 4 (Telehealth Services); Chs. II and III Section 31 (Federally Qualified Health Center Services); Chs. II and III Section 40 (Home Health Services); Chs. II and III Section 45 (Hospital Services); Ch. II Section 55 (Laboratory Services); Ch. II Section 60 (Medical Supplies and Durable Medical Equipment); Chs. II and III Section 65 (Behavioral Health Services); Ch. II Section 80 (Pharmacy Services); Ch. II Section 90 (Physician Services); Chs. II and III Section 96 (Private Duty Nursing and Personal Care Services; Ch. II Section 101 (Medical Imaging); and Chs. II and III Section 103 (Rural Health Clinic Services).
The Department is waiving certain co-payment requirements for all MaineCare members, including pharmacy, clinical visits, medical imaging, laboratory services, behavioral health services, medical supplies and durable medical equipment, private duty nursing, and home health services. Should COVID-19 specific treatments or vaccines become available during the duration of this rule, co-payments will be waived for those services as well.
The Department is altering some of the MBM Section 80, Pharmacy Services, requirements in order to expedite and improve access to prescriptions. Restrictions are lifted for asthma and immune-related prescriptions. Prior Authorizations for COVID-19 treatments and vaccines, should they come available, are waived. Early refills of prescriptions are allowed, and the physical assessment requirements for Buprenorphine and Buprenorphine Combination products for SUD are waived.
Prior Authorization requirements for certain durable medical equipment are being extended and early refills allowed for individuals with COVID-19, awaiting test results for COVID-19, or in the high-risk category for developing complications from COVID-19.
Home Health Services document submission requirements are being extended for Plans of Care submissions.
The Department is waiving the advance written notice/consent for telehealth services, waiving the comparability requirement for services specifically approved by the Department, and allowing telephone-only evaluation and management services.
In the event of conflict between the COVID-19 Public Health Emergency Services rule and any other MaineCare rule, the terms of this rule supersede other rules and shall apply.
The Department shall seek and anticipates receiving approval of those changes from the Centers for Medicare and Medicaid Services (CMS) retroactive to March 18, 2020.
Except for the changes affecting MBM, Chs. II and III Section 40, Home Health Services, these emergency rule changes shall be effective for ninety (90) days, per 5 MRS §8054. MBM Chs. II and III Section 40, Home Health Services, are major substantive rules, thus, if CMS approves, the emergency rules changes affecting Section 40 shall be effective for up to one year pursuant to 5 MRS §8073.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: March 20, 2020
AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner II, Division of Policy, 109 Capitol Street - 11 State House Station, Augusta, Maine 04333-0011. Telephone: (207) 624-4082. Fax: (207) 287-1606. TTY users call Maine relay 711. Email: Anne.Labonte@Maine.gov.
OMS RULES WEBSITE: https://www.maine.gov/dhhs/oms/rules/index.shtml.
OMS WEBSITE: http://www.maine.gov/dhhs/oms/.
DHHS WEBSITE: http://www.maine.gov/dhhs/.
OMS RULEMAKING LIAISON: Thomas.Leet@Maine.gov.
DHHS RULEMAKING LIAISON: Kevin.Wells@Maine.gov.