Resolve, To Ensure Coordination and Effectiveness in the Provision of Services under the MaineCare Noncategorical Waiver

Sec. 1. Development of processes. Resolved: That the Department of Health and Human Services shall ensure the coordination and effective provision of MaineCare services provided to noncategorical members eligible for benefits under the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraph F, referred to in this section as “noncategorical members,” by:

1. Implementing a process for tracking the number of mental health treatment sessions provided to noncategorical members for purposes of appropriate clinical planning;

2. Establishing and implementing prior authorization processes to aid in ensuring that a noncategorical member’s remaining service availability is not exhausted within any given calendar year;

3. Creating criteria for necessary clinical justification for exceeding the calendar year limit of outpatient services. The department may increase the maximum number of visits for outpatient mental health services, excluding visits for medication management, to 24 visits in a 12-month period as long as any cost associated with this increase is offset by savings from managing the utilization of this service by methods that may include prior authorization;

4. Developing systems to enable providers to identify the eligibility category of noncategorical members, the members’ enrollment dates and the members’ recertification dates;

5. Developing systems for transition planning for noncategorical members who leave or become ineligible for the MaineCare program; and

6. Providing a priority reinstatement process for certain noncategorical members who have good cause for failing to recertify their eligibility or placement on the waiting list in a timely manner.

The department may adopt routine technical rules, as defined in Title 5, chapter 375, subchapter 2-A, as needed to implement this section.