From provider at lists.maine.gov Tue Aug 5 15:42:58 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 5 Aug 2008 15:42:58 -0400 Subject: [Provider] Proposed MaineCare Rule for Adult Family Care Services Message-ID: ATTENTION: All MaineCare Providers of Adult Family Care Services MaineCare Services is proposing the following for 10-144 MaineCare Benefits Manual, Chapter II, Section 2, "Adult Family Care Services". Concise Summary: The Department is proposing these rules to permanently adopt emergency rules currently in place. * This rule will increase the limit of reimbursable beds in an Adult Family Care Home from six to eight beds. * This rule will also add an additional type of licensure that Adult Family Care Homes may have in order to be reimbursed appropriately when the facility has more than six beds. Currently Adult Family Care Homes must be licensed as an Assisted Living Program: Level III Residential Care Facility. Those facilities with more than six beds will require licensure as an Assisted Living Program: Level IV Residential Care Facility. Public Hearing: August 20, 2008, 1:00 PM Conference Room 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before August 13, 2008. Deadline for Comments: Comments must be received by midnight August 31, 2008. Agency Contact Person: Patricia Dushuttle This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080805/ba9fc1a0/attachment.html From provider at lists.maine.gov Tue Aug 5 15:43:13 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 5 Aug 2008 15:43:13 -0400 Subject: [Provider] Proposed MaineCare Rule for Chapter II, Section 21 Message-ID: ATTENTION: All Maine Providers of services under the MaineCare Benefits Manual, Chapter II, Section 21 MaineCare is proposing rule changes related to Home and Community Benefits for Members with Mental Retardation or Autistic Disorder. Concise Summary: The proposed rule reorganizes Community Support as part of P. L. 2007, c. 539, ? A-27 to have one model of support where formerly there were two models (A & B) of support. This change is necessary to reduce expenditures for this service in accordance with the budget for FY 08-09. Other than providers of these specific services, this rule is not expected to fiscally impact or create new recording burdens for other small businesses and is not expected to yield new costs for municipal or county governments. PUBLIC HEARING: August 25, 2008, 1:00- 3:00 PM Conference Room # 1A & B Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Deadline for Comments: Comments must be received by midnight September 4, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080805/23c80f99/attachment.html From provider at lists.maine.gov Tue Aug 5 15:43:31 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 5 Aug 2008 15:43:31 -0400 Subject: [Provider] MaineCare Proposed Rule for Chapter II & III, Section 29 Message-ID: ATTENTION: All MaineCare Providers of services under the MaineCare Benefits Manual, Chapter II & III, Section 29 MaineCare Services is proposing changes for Community Support Benefits for Members with Mental Retardation and Autistic Disorders. Concise Summary: This proposed rule reorganizes Community Support as part of P. L. 2007, c. 539, ? A-27 to have one model of support where formerly there were two models (A & B) of support. This change is necessary to reduce expenditures for this service in accordance with the budget for FY 08-09. Other than providers of these specific services, this rule is not expected to fiscally impact or create new recording burdens for other small businesses and is not expected to yield new costs for municipal or county governments. Public Hearing: August 25, 2008, 1:00-3:00 p.m. Conference Room # 1A & B Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Deadline for Comments: Comments must be received by midnight September 4, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080805/72162cef/attachment.html From provider at lists.maine.gov Tue Aug 5 15:43:55 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 5 Aug 2008 15:43:55 -0400 Subject: [Provider] A Reminder for Super 65 Providers Billing New Codes Beginning August 1 Message-ID: ATTENTION: All MaineCare "Super 65" Providers All Super 65 providers should begin using the new procedure codes to bill for services, starting August 1. A MeCMS Prior Authorization billing number will not be required for these services until September 1. This is to allow providers adequate time to re-register their clients with APS Healthcare. In other words, providers may bill for Outpatient and Med Management services in August, using the new procedure codes, and are not required to submit a MeCMS PA Billing Number with their claims. Starting September 1, all MaineCare claims for these services must be submitted with a MeCMS PA Billing Number. This applies (only) to the following codes: H2000 H2000HH H0004 H0004HH H0004HQ H0004HQHH H2010 This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080805/238add2c/attachment.html From provider at lists.maine.gov Tue Aug 5 15:42:41 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 5 Aug 2008 15:42:41 -0400 Subject: [Provider] Proposed MaineCare Rule for Behavioral health Services Message-ID: ATTENTION: MaineCare Providers of services under MaineCare Benefits Manual, Chapters II & III, Sections 58, 65, 100 and 111 Rule Titles and Subjects: MaineCare Benefits Manual, Chapters II & III: Sections 58, Licensed Clinical Social Worker, Licensed Clinical Professional Counselor and Licensed Marriage and Family Therapist Services, Section 65, Mental Health Services, Section 100, Psychological Services, Section 111, Substance Abuse Treatment Services and a replacement with Section 65 which will now be titled Behavioral Health Services. Concise Summary: The proposed rule consolidates Outpatient Services under one Section of the MaineCare Benefits Manual, ensuring better coordination of services. Specifically: * Emergency Services, which used to be covered as a stand alone service, has been incorporated into Outpatient services. * Comprehensive Assessment, which was incorporated into Outpatient Services, is being covered and coded for reimbursement as a stand alone service. * This rulemaking also adds proration language for partial months of Children's Assertive Community Treatment (ACT) in Chapter II. * Crisis Services have been renamed and redefined to better reflect current services being provided. * Child and Family Behavioral Health Treatment and Community Based Treatment for Children Without Permanency have been merged into one service and renamed Children's Home and Community Support Services for better coordination. * Collateral contacts have also been added as a stand alone service for children who receive Children's Home and Community Support Services. Independent providers not employed by a Mental Health Agency will be able to provide within the scope of their licensure and be reimbursed for services provided to MaineCare members. * Additionally, the Chapter III of this new Section will contain HIPAA compliant coding. Other than providers of these specific services, this rule is not expected to fiscally impact or create new recording burdens for other small businesses and is not expected to yield new costs for municipal or county governments. Public Hearing: Monday, August 11, 2008, 12:30-3:30 Conference Room # 1A&B Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04333 DEADLINE FOR COMMENTS: Comments must be received by midnight, Thursday August 21, 2008 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080805/a043ae71/attachment.html From provider at lists.maine.gov Tue Aug 5 15:42:24 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 5 Aug 2008 15:42:24 -0400 Subject: [Provider] MaineCare Emergency Rules for Behavioral Health Services Message-ID: ATTENTION: MaineCare Providers of services under the MaineCare Benefits Manual Chapter 101 and Chapters II and III, Section 65 The two rules listed below are emergency rules will be in effect for no more than 90 days. These rules must be proposed and final adoption will be filed. 1. Emergency Rule: MaineCare Benefits Manual, Chapter 101, Chapters II & III, Section 65, Behavioral Health Services Concise Summary: The emergency rule repeals Sections 58, Licensed Clinical Social Worker, Licensed Clinical Professional Counselor and Licensed Marriage and Family Therapist Services; Section 65, Mental Health Services; Section 100, Psychological Services; and Section 111, Substance Abuse Treatment Services and replaces them with one consolidated rule which will now be known as Section 65, Behavioral Health Services. There will be no public hearing with this emergency rule. The Department will hold a public hearing as part of the rulemaking that will permanently adopt these emergency rules. P. L. 2007, ch. 539, Part JJJ authorizes the Department to file these emergency rules. Effective Date: August 1, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner 2. Emergency Rule: MaineCare Benefits Manual, Chapter 101, Chapter III, Section 65, Behavioral Health Services Concise Summary: This emergency rule replaces Chapter III of the emergency rulemaking the Department filed on July 17, 2008. * This chapter III changes four procedure codes to "BY REPORT" to correct errors in the rate published in the earlier rulemaking. * The codes that should be listed as "By Report" are H2011, H0018, S9482, and ZNC16. * Providers may discard the first published chapter III and replace it with this chapter III. The Department will hold a public hearing as part of the rulemaking that proposes to permanently adopt these emergency rules along with Chapter II of the first rulemaking. P. L. 2007, ch. 539, Part JJJ authorizes the Department to file these emergency rules. Effective Date: August 1, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080805/414e3cde/attachment.html From provider at lists.maine.gov Thu Aug 7 14:43:25 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 7 Aug 2008 14:43:25 -0400 Subject: [Provider] Submission of new Section 65 outpatient codes for authorization to APS Healthcare Message-ID: ATTENTION: MaineCare ASO Providers Important- please use the following instructions when submitting the new Section 65 Outpatient codes for authorization to APS Healthcare. Comprehensive Assessment Procedure Codes: Codes H2000 and H2000HH 1. Codes H2000 and H2000HH may not be authorized simultaneously. 2. Code H2000 may not be authorized more than once, for a given member, for a given provider billing number, in a given time period. 3. For requests submitted after 8/8/08, If a provider requests authorization for both codes in a single request, the request will be administratively closed, and the provider must resubmit the request with a single code. Outpatient Therapy Individual/Family: Codes H0004 and H0004HH 1. Codes H0004 and H0004HH may not be authorized simultaneously. 2. Code H0004 may not be authorized more than once, for a given member, for a given provider billing number, in a given time period. Outpatient Therapy Group: Codes H0004HQ and H0004HQHH 1. Codes H0004HQ and H0004HQHH may not be authorized simultaneously. 2. Code H0004 may not be authorized more than once, for a given member, for a given provider billing number, in a given time period. If an agency is providing both individual therapy and substance abuse therapy to a member in the same time period, with two different therapists, the agency must request authorization for mental health and substance procedure codes in two separate requests: 1. Assessment (H2000) and Treatment (H0004) with the appropriate mental health Provider Billing ID in one request and 2. Assessment (H2000) and ONE of the Substance Abuse Treatment choices (code H0004), along with the appropriate substance abuse Provider Billing ID. Two different MeCMS PA numbers will be issued for these two requests. If a Substance Abuse agency is providing outpatient substance abuse services that alternate frequently between Non-Masters Level LADC, CADC and/or other staff, the agency must request only a single procedure code H0004, for that member and for that time period. It is the provider's choice which listed version of H0004 they select in APS CareConnection. That choice will not affect billing. The provider may bill for different staff using that single procedure code, Provider Billing ID and MeCMS PA Number. If a Substance Abuse agency requests authorization for H0004 more than once in a single request, the request will be administratively closed, and the provider must resubmit the request with a single code. Re-Registration If a member is in outpatient service prior to 8/1/08 and being re-registered with the new procedure codes, no Assessment procedure code will be authorized. All requests for an Assessment procedure code for re-registrations will be administratively closed. If a provider has already submitted a request inconsistent with these instructions, APS Healthcare Provider Relations staff will contact you to make needed corrections. Please contact the APS Healthcare Provider Relations Team if you have questions. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080807/a0e2f8b9/attachment.html From provider at lists.maine.gov Mon Aug 11 14:15:15 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 11 Aug 2008 14:15:15 -0400 Subject: [Provider] Interim Guidelines for Fifteen-Minute Billing for Children's Targeted Case Management Services under MaineCare Benefits Manual Section 13.12 Message-ID: ATTENTION: MaineCare Providers Providing Children's Targeted Case Management Services Fifteen-minute billing will be in effect for Children's Targeted Case Management Services, MBM, Section 13.12 on September 1, 2008 pursuant to rate letters that will be issued to all current providers. 1. The Office of MaineCare Services, customer service division will be available to answer any questions about billing. 2. Only one staff person's time is reimbursable for any specific covered service activity during any given billing period. 3. Any and all billable activities must meet covered services requirements. 4. All current requirements for the frequency and provision of service remain the same. 5. All covered services must be billed on fifteen-minute increments. a. There are no minimum time requirements for the first 15 minutes of billing for a client. b. Second and subsequent 15 minute encounters/activities must go beyond 7.5 minutes to bill. 6. Client eligibility, covered services, non-covered services, documentation and staffing qualification requirements will continue as specified under current Section 13.12 MaineCare policy. 7. APS Healthcare instructions in response to these changes in MaineCare are attached to this notice. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080811/10391ffb/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: TCM Billing Unit Changes Service Grid Revision for 9-1-08.doc Type: application/msword Size: 102400 bytes Desc: TCM Billing Unit Changes Service Grid Revision for 9-1-08.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080811/10391ffb/TCMBillingUnitChangesServiceGridRevisionfor9-1-08.doc From provider at lists.maine.gov Tue Aug 12 11:51:34 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 12 Aug 2008 11:51:34 -0400 Subject: [Provider] Billing Update for Residential Care Facilities Message-ID: ATTENTION: All MaineCare Providers Previously Billing "Bed Hold" Days Effective 8/1/08, new rules went into effect that discontinue MaineCare payments for so-called "bed hold" days. This is being done in conjunction with a budget initiative and in order to comply with federal requirements. In order to help defray the fixed costs associated with temporary absences, and to ensure that facilities continue to have the capacity to hold beds for residents during short term absences, the Department is increasing MaineCare rates for residential care providers by $1.52 per day. In addition, the Department will continue to pay the routine component (which is paid with state funds) for bed hold periods of up to 30 days. Providers should continue to use procedure codes BQ, BP, RMR or MRP to bill for Medical and Remedial Services and for Personal Care Services. Billing is only allowed for days that a member receives covered services from the facility. Billing should continue for the routine component using procedure code BH or MRB for the days that a member is in the facility and BHL or MRBL for bed hold days of up to 30 days when a member is on a leave from the facility. In the aggregate, the net savings from these changes are equivalent to the amount spent last year for bed holds in excess of 30 days, based on paid claims data. We recognize that these changes will require providers to change the way they manage bed holds, especially longer term absences. In addition, we recognize that meeting the needs of residents who must leave a residential facility for higher levels of care will require flexibility on the part of providers. For example, policy changes to give priority in the admission process to residents returning from longer term absences should be adopted in order to provide continuity for those residents. We look forward to working with providers to implement these changes in a manner that will minimize disruptions for residents of residential care facilities. Please contact the MaineCare provider relations office at 1-800-321-5557, Option 9 for further assistance. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080812/2a708b64/attachment.html From provider at lists.maine.gov Wed Aug 13 12:52:32 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 13 Aug 2008 12:52:32 -0400 Subject: [Provider] Revised Billing Update for Residential Care Facilities Message-ID: ATTENTION: All MaineCare Providers Previously Billing for "Bed Hold" Days The listserv message sent yesterday on this topic incorrectly stated some of the procedure codes providers should now use. The corrected paragraph follows: Providers should continue to use procedure codes BQ, BP, or MRP to bill for Medical and Remedial Services and for Personal Care Services. You may only bill for days that a member receives covered services from the facility. Billing is only allowed for the routine component using procedure code BH or MRB for the days that a member is in the facility and BL or MRBL for bed hold days of up to 30 days when a member is on a leave from the facility. We do apologize for any confusion this error may cause. Please contact the MaineCare provider relations office at 1-800-321-5557, Option 9 for further assistance. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080813/20e8e432/attachment.html From provider at lists.maine.gov Mon Aug 18 08:20:50 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 18 Aug 2008 08:20:50 -0400 Subject: [Provider] Proposed MaineCare Rule for Hearing Aids and Services Message-ID: ATTENTION: All MaineCare Providers of Hearing Aids and Services This is notice of proposed rulemaking within the MaineCare Benefits Manual, Chapter II and III, Section 35, Hearing Aids & Services and Allowances for Hearing Aid Services. Concise Summary The Department has proposed changes to this section to adjust the policy to reflect the current practice of only allowing providers to bill for members under the age of 21 under this section. Other proposed changes to this section of policy are being made to eliminate the use of local codes and provide alternate codes to replace them. Due to these required code changes, prior authorization language is being updated. This rule is not expected to fiscally impact or create new recording burdens for any small businesses and is not expected to yield new costs for municipal or county governments. Public Hearing September 8, 2008 * 10:00 am -12:00 Noon Department of Health and Human Services Office of MaineCare Services Conference Room #2 442 Civic Center Drive Augusta, ME 04330 Deadline for Comments Comments must be received by midnight Sept 18, 2008. This is notice of a rule that has recently been proposed. The text of the rule and other information is on the MaineCare Services website. The link to that website is: http://www.maine.gov/dhhs/bms/rules/provider_rules_policies.htm This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080818/12c5bb31/attachment.html From provider at lists.maine.gov Mon Aug 18 09:00:08 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 18 Aug 2008 09:00:08 -0400 Subject: [Provider] Billing Reminder for the New MaineCare Behavioral Health Services, Section 65 Rules Message-ID: ATTENTION: MaineCare Providers of Behavioral Health Services Providers billing for services within the new MaineCare Benefits Manual, Section 65 are reminded that the new codes are to be used for services provided beginning August 1, 2008. Services provided prior to August 1 should be billed using the former codes. In addition, a crosswalk linking new and previous codes is attached. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... 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