[Provider] MaineCare Proposed Rule for Targeted Case Management Services and Allowances for Targeted Case Management Services

[Provider Notification]

ATTENTION:  MaineCare Providers of Targeted Case Management Services

 

RULE TITLE OR SUBJECT: 

MaineCare Benefits Manual, Chapters II and III, Section 13

 

CONCISE SUMMARY: 

This proposed rule repeals and replaces the existing Chapters II and III
of Section 13, Targeted Case Management Services and Allowances for
Targeted Case Management Services, in accordance with the federal
mandate. The proposed rule complies with the mandate of the federal
Medicaid regulation amendment (see 72 Fed. Reg. 68,077 (Dec. 4, 2007)
(Interim final rule, to be codified at 42 C.F.R. Parts 431, 440 and 441)
which institutes major changes including restrictive definitions of
covered TCM services, and major changes to provider reimbursement and
billing. The proposed rule defines TCM covered services; clarifies that
MaineCare will not cover duplicative services; and sets forth the
eligibility process, and the federal requirement of transitioning to one
comprehensive case manager. Chapter III establishes new billing
procedure codes based on HIPAA compliant HCPCS coding. Chapter III also
implements a change in reimbursement to the Provider/Case Management
Agency through the requirement of billing in fifteen (15) minute
increments, and also requires comprehensive documentation of services by
providers. The Department will comply with all federal noticing
requirements to both recipients and providers.  The Department is
currently working with CMS on a State Plan amendment which will comply
with the federal TCM regulation.

 

PUBLIC HEARING: 

April 23, 2008, 12:00 PM 

Commerce Center, Florian Hall 

45 Commerce Drive

Augusta, ME 

 

DEADLINE FOR COMMENTS: 

Comments must be received by midnight May 3, 2008.

 

AGENCY CONTACT PERSON:       

Melanie Miller, Comprehensive Health Planner

Office of MaineCare Services

442 Civic Center Drive

Augusta, ME  04333

 

TELEPHONE:            207-287-4459 

FAX:                            207-287-9369 

TTY:                            1-800-423-4331 or 207-287-1828 (Deaf or
Hard of Hearing)

 

A listing of proposed, emergency and recently adopted rules can be found
on the MaineCare Services web site at:

http://www.maine.gov/dhhs/bms/rules/provider_mcare_benefit.htm

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

 

 

 

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