An Act To Require the Department of Health and Human Services To Annually Update Its Rules Governing Services for Children with Cognitive Impairments and Functional Limitations

Sec. 1. 22 MRSA §3174-YY  is enacted to read:

§ 3174-YY.  Coverage of rehabilitative and community support services for children with cognitive impairments and functional limitations

The department shall by July 1st of each year amend its rules to provide coverage and reimbursement for emerging evidence-based treatments that are rehabilitative and community support services for children with cognitive impairments and functional limitations. For the purposes of this section, "evidence-based treatments" means treatments that are identified by a working group consisting of department staff, providers of services, family members of children who receive services and advocates for children that integrate the best available research with clinical expertise in the context of patient characteristics, culture and preference. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

Sec. 2. Rulemaking. By October 1, 2015, the Department of Health and Human Services shall amend its Rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 28 regarding specialized services as follows:

1. Section 28.01-14 must be amended to include medically necessary treatment services that utilize the process of systematically applying interventions based upon empirically derived principles of behavior or development to improve socially significant behaviors to a measurable degree, and to demonstrate that interventions employed are effective in improving behavior. Section 28.01-14 must also be amended to specify that assessment includes systematic information gathering including interview, direct observation and other evidence-based tools and measures; and

2. Section 28.04-2 must be amended to include as specialized services for children with cognitive impairments and functional limitations evidence-based treatment services for members under 21 years of age that utilize interventions designed to improve socially significant behaviors and developmentally appropriate skills to a measurable degree. The services must include problem-solving activities with members and member caregivers.

SUMMARY

This bill requires the Department of Health and Human Services to annually update MaineCare coverage for rehabilitative and community support services for children with cognitive impairments and functional limitations. The bill also requires the department to amend MaineCare rules for those services, specifically amending the definitions of and coverage for specialized services and specialized services for children with cognitive impairments and functional limitations.