‘Resolve, To Assist Maine Schools To Obtain Federal Funds for Medically Necessary Services’

‘Emergency preamble. Whereas,  acts and resolves of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and

Whereas,  this resolve is intended to provide guidance regarding those portions of the Department of Health and Human Services' MaineCare rules that relate to implementation of special education and related services provided through the Child Development Services System and school administrative units to eligible children served in these settings; and

Whereas,  it is critical that the Department of Education and the Department of Health and Human Services work together with key stakeholders to develop refinements to existing MaineCare policies or develop new policies and guidance on billing procedures as soon as possible to ensure the provision of medically necessary services to students in school-based settings; and

Whereas,  the Department of Education and the Department of Health and Human Services must begin the process of refining current MaineCare policies, developing guidance on billing procedures and preparing any necessary revisions to the state plan to submit to the Federal Government for review and approval prior to the adoption of rules governing Medicaid payment for medically necessary services to eligible children in school-based settings that qualify for reimbursement; and

Whereas,  in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now, therefore, be it

Sec. 1. Refinement of MaineCare policies. Resolved: That the Department of Education and the Department of Health and Human Services, referred to in this section as "the departments," shall work together to refine existing policies, develop new policies or prepare nonregulatory guidance on billing procedures, as appropriate, to ensure the provision of medically necessary services to students in school-based settings. The refinements to MaineCare policies must:

1. Be in compliance with federal law;

2. Provide local school districts with options and give them the authority to choose the best option with regard to local needs and capacities;

3. Take into consideration the input of stakeholders, including representatives of the Department of Education, the Department of Health and Human Services, the Child Development Services System, the Maine School Management Association, the Maine Administrators of Services for Children with Disabilities and special purpose private schools and agencies that are approved to provide early intervention or special education programs pursuant to the Maine Revised Statutes, Title 20-A, section 7252-B. In order to gather input from stakeholders, the departments shall establish work groups to explore problems with current Medicaid policies and to consider possible solutions to both policies and billing processes. The work groups must include stakeholders and representatives of the following groups, who participate as nonvoting members:

4. Include provisions for training and support for school staff, including the development of policy and billing manuals and other resources written with school-based providers in mind; and

5. Set up an interagency stakeholder body, including representatives of the Department of Education, the Department of Health and Human Services, the Child Development Services System, the Maine School Management Association, the Maine Administrators of Services for Children with Disabilities and special purpose private schools and agencies that are approved to provide early intervention or special education programs pursuant to the Maine Revised Statutes, Title 20-A, section 7252-B, to coordinate the implementation of the program refinements. The interagency stakeholder body must also include representatives of the following groups, who participate as nonvoting members:

Sec. 2. State plan amendment. Resolved: That, after due consideration of the input of the stakeholders and relevant work groups established pursuant to section 1, if determined to be appropriate by the Department of Education and the Department of Health and Human Services, the Department of Health and Human Services shall propose changes to the state plan for Medicaid services provided pursuant to the Maine Revised Statutes, Title 22, chapter 855 to permit reimbursement for school-based services by July 1, 2012; and be it further

Sec. 3. Report to Legislature. Resolved: That the Department of Education and the Department of Health and Human Services shall report to the joint standing committee of the Legislature having jurisdiction over education and cultural affairs and the joint standing committee of the Legislature having jurisdiction over health and human services matters on March 30, 2012 on the status of the work undertaken to that date pursuant to this resolve. The report must include, but is not limited to, a timeline that establishes specific dates for each of the following initiatives:

1. Proposed policy changes, including refinements to existing policies, new policies to be developed or the preparation of nonregulatory guidance on billing procedures;

2. A communication plan to provide details on the implementation of proposed policy changes to the field;

3. A plan to provide the training required to school administrative units and the Child Development Services System;

4. A detailed budget, including the amount and sources of funding and other resources needed to implement proposed policy changes;

5. If determined to be appropriate by the Department of Education and the Department of Health and Human Services, a plan to make any necessary changes to rules; and

6. If determined to be appropriate by the Department of Education and the Department of Health and Human Services, a timeline for the preparation, submission and anticipated approval of amendments to the state plan for Medicaid services provided pursuant to the Maine Revised Statutes, Title 22, chapter 855 related to the provision of medically necessary services to eligible children in school-based settings.

In addition, the Department of Education and the Department of Health and Human Services shall jointly submit a status report on a monthly basis through June 2012 on the work completed by the Department of Education and the Department of Health and Human Services and the interagency stakeholder body pursuant to this resolve; and be it further

Sec. 4. Goal. Resolved: That the goal of this resolve is to make sure eligible children get the services they need in the settings they need them in and to ensure those services that qualify as medically necessary services are reimbursed.

Emergency clause. In view of the emergency cited in the preamble, this legislation takes effect when approved.’