From provider at lists.maine.gov Fri Dec 5 13:54:12 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Dec 2008 13:54:12 -0500 Subject: [Provider] Sterilization Consent Forms Message-ID: ATTENTION: Providers who use Sterilization Consent Forms The Sterilization Consent form is available on line at http://www.hhs.gov/forms/HHS-687.pdf . You can fill out the form electronically, and then print for wet signatures. You can also save it to your local computer drive. We encourage you to use this on-line form. If you do not have on-line access, you may call GHS at 207-622-7153 and request paper forms. Quick Reminder: A Sterilization Consent form is good for 180 days from the date it is signed. If the consent is already 180 days old, the patient should sign a new one. The procedure should occur at least 30 days after the patient signs. _______________________________________________________________________ If you would rather not get these e-mails, please visit OMS List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081205/168f5d98/attachment.html From provider at lists.maine.gov Wed Dec 10 11:26:58 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 10 Dec 2008 11:26:58 -0500 Subject: [Provider] Receipt of MaineCare Claims by Modem Ends Friday, December 5 Message-ID: ATTENTION: MaineCare Providers currently sending claims by modem This is a reminder of a notice sent by listserv in October. The last day that claims may be submitted to MaineCare by modem is Friday, December 5th. A summary of the original message is here: Providers sending claims to MaineCare by modem may experience delays or other problems in the transfer of those claims. The technology used for this process is older and problems like this may continue to occur over time. For this reason, we are asking that any providers still using modem to submit their claims change to sending their claims by file transfer (FTP). Please make this change by Friday, December 5th. This is the last day that modem submission of claims will be supported by MaineCare. Providers will find that sending claims by FTP is faster and more reliable. If you have questions about this, please call 800-321-5557, option 9. 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/20081210/619bbe15/attachment.html From provider at lists.maine.gov Tue Dec 16 09:30:26 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 16 Dec 2008 09:30:26 -0500 Subject: [Provider] Payment Schedule during Holiday Weeks Message-ID: ATTENTION: PROVIDERS PAID THROUGH MECMS AND EXPECTING PAYMENT THE WEEKS OF 12/22/2008 AND 12/29/2008 Because of the holidays on December 25 and January 1, MaineCare will have a different payment schedule for those two weeks. * Electronic Funds Transfers (EFTs) will be released on the Wednesday each week (December 24th and December 31st) o EFTs should be received on that night or the following Friday (December 26th and January 2nd) depending on the EFT vendor. * Checks and Remittance Advices (RAs) will be sent as usual: o Monday, December 29th to be received by Friday, January 2nd and, o Monday, January 5th to be received by Friday, January 9th. * Provider Pay Order Dates will be Tuesday rather than Wednesday * Claims submitted on Friday, December 19th and Friday, December 26th will go into the following week's processing. If you have questions, feel free to contact Customer Service at 1-800-321-5557 Option #8. Happy Holidays! If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081216/c86b305d/attachment.html From provider at lists.maine.gov Tue Dec 16 10:36:52 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 16 Dec 2008 10:36:52 -0500 Subject: [Provider] MaineCare Services Web Site Updates Message-ID: ATTENTION: All MaineCare Providers The December edition of MaineCare Matters has been posted and can be found at http://www.maine.gov/dhhs/bms/member/innerthird/mainecare_matters.html In addition, the Fiscal Agent section of the MaineCare web site has been updated with new information and a Frequently Asked Question list. This can be found at http://www.maine.gov/dhhs/bms/member/innerthird/fiscal_agent.html Additional questions related to the Fiscal Agent project and the implementation of a new Medicaid Management Information System should be sent to MaineCare2010.DHHS at maine.gov 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/20081216/5312540a/attachment.html From provider at lists.maine.gov Tue Dec 23 10:20:40 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 23 Dec 2008 10:20:40 -0500 Subject: [Provider] MaineCare Services Rule Making for Nursing Facilities Message-ID: ATTENTION: MaineCare Nursing Facility Providers This is notice of emergency and proposed rule making for Chapter III, Section 67 of the MaineCare Benefits Manual, Principles of Reimbursement for Nursing Facilities. Emergency Rule Concise Summary: In this emergency rule making, the Department is implementing changes in the rate methodology as well as providing an additional one time payment for the quarter between October 1, 2008 and December 31, 2008. Specifically, the rate methodology alters the base year from 1998 to 2005. The rule also establishes a new prospective per diem rate by adding a direct care regional cost component and a hold harmless provision to the rule. Other changes are made in this rule making that include changes in medical director costs and waiver of administrator costs that are included under the management ceiling. The Department has budgeted $9,388,889 (federal and state funds) for FY '09 for this rate methodology change. This amount is derived out of the original $16,353,230 appropriated by the State Legislature, Public Law 2007, Ch. 240, Pt. A., after other budgetary changes were made. Effective Date: December 16, 2008 - March 15, 2009 Proposed Rule Concise Summary: The Department is proposing this rule to permanently adopt the emergency rules that went into effect on December 16, 2008. Specifically, the Department is proposing to change the base year that is used to calculate direct care and routine care costs from 1998 to 2005. In addition, language is added to waive the principle that combines the administrator costs and other services that an administrator may be delivering under the Administration and Management ceiling. This specific change will only be applicable for single-level facilities with forty (40) or fewer beds. The Department also proposes language that increases the cap for medical director costs from $1200 to $10,000. Furthermore, the Department proposes to amend the language that establishes the prospective per diem rate, by adding a direct care regional cost component to the rule. The Department also proposes to make a one-time rate adjustment in addition to the base rate adjustment for the time period between October 1, 2008 and December 31, 2008. A new subsection is also added that establishes that all new NF beds converted to Residential care beds must have a private pay source. Other minor technical and grammatical changes are also included in this rule proposal. The proposed rate changes will increase expenditures for nursing facility services by $9,388,889 (federal and state funds) for FY '09. Public Hearing: January 12, 2009, 1:00 p.m. 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 January 5, 2009. Deadline for Comments: Comments must be received by midnight January 22, 2009. Contact: Allyssa Morrison, MaineCare policy writer at Alyssa.morrison at maine.gov Web Posting: The emergency and proposed rule will be posted to the MaineCare Services web site at http://www.maine.gov/dhhs/bms/rules/prov_other_rules.htm Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. A reply to this message will not receive a response. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081223/254797df/attachment.html From provider at lists.maine.gov Fri Dec 26 13:55:21 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 26 Dec 2008 13:55:21 -0500 Subject: [Provider] Physician Fee Changes Message-ID: ATTENTION: Physicians who bill for MaineCare Services under Section 90 RE: Some Physician Fees Increased December 24, 2008 On December 24, 2008, MaineCare's physician fees on certain procedure codes increased from 53% to 56.94% of Medicare's 2008 rate. A complete list of the codes receiving increases is available at http://www.maine.gov/dhhs/bms/member/innerthird/news_page.shtml (Click "Physician Fee Revision.") The increase applies only to physicians billing for services under MaineCare Benefits Manual Section 90, Physician Services. It does not apply to procedure codes billed under Section 55 Laboratory Services, Section 95 Podiatric Services, Section 101 Medical Imaging, or Section 75 Vision Services. Here is a summary of how the claims will be processed: * The rate increase is retroactive to July 1, 2008. * Claims billed for services provided December 24th and after will receive the new MaineCare rate. * Claims yet to be filed for dates of service July 1, 2008 through December 23, 2008: Please file them using your usual charges rate. You will be paid the lower of your usual charges or the new MaineCare rate. * Claims filed for dates of service July 1, 2008 through December 23, 2008: If you filed using your usual charges rate, and that rate was higher than the old MaineCare rate, the claims system will automatically adjust the claim to the lower of your usual charges or the new MaineCare rate. You will be paid the difference in one of your regular checks. * We will issue another communication for claims for dates of service July 1, 2008 through December 23, 2008 that were billed using the old MaineCare rate or for services that required Prior Authorization. Feel free to contact Customer Service with questions at 1-800-321-5557 Option #8. Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081226/2e21538e/attachment.html From provider at lists.maine.gov Mon Dec 29 09:34:54 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 29 Dec 2008 09:34:54 -0500 Subject: [Provider] Code Updates Message-ID: ATTENTION: Providers who bill using HCPC codes The National Uniform Billing Committee (NUBC) has updated codes for January 1, 2009. The following revenue codes will no longer be valid: 0789 Telemedicine- Other Telemedicine 0799 Other Lithotripsy The attached list of CPT/HCPC codes will also be discontinued. MaineCare will make other regular quarterly code updates for January 1. If you have questions about billing, codes, or claims, please feel free to contact Customer Service at 1-800-321-5557 Option #8. Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081229/957eef19/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: 2009_Discontinued_HCPCS.doc Type: application/msword Size: 71680 bytes Desc: 2009_Discontinued_HCPCS.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20081229/957eef19/2009_Discontinued_HCPCS.doc From provider at lists.maine.gov Wed Dec 31 16:22:25 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 31 Dec 2008 16:22:25 -0500 Subject: [Provider] Emergency Rules References: Message-ID: Below are four emergency adopted rules which go into effect this week. CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 22, Home and Community Benefits for the Physically Disabled CONCISE SUMMARY: This rule making immediately adopts a rate change for Personal Care Attendant Services by changing the rate from $2.28 to $2.57 per quarter hour. This rate change is necessary to comply with the federal requirements governing the recently submitted waiver amendment that governs this program. This waiver amendment defines a new institutional level of care which allows for a higher rate of reimbursement for personal care attendant services under this section. Permanent changes will be contingent upon CMS approval. EFFECTIVE DATE: December 31, 2008 - March 30, 2009 AGENCY CONTACT PERSON: Alyssa Morrison, Health Planner TELEPHONE: (207)-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ===================================================================================== CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities CONCISE SUMMARY: This emergency rule adopts a rate reduction for the comprehensive care management service listed under this section. Specifically, the rate is being reduced to $126.50 per month from $139.00 per month. This is written in the approved budget curtailment which expects to save $62,600 in the General Fund in SFY 09 as a result of this rate change. This rule making is not expected to impose administrative costs on small businesses, counties or municipalities. EFFECTIVE DATE: January 1, 2009 - March 31, 2009 AGENCY CONTACT PERSON: Alyssa Morrison, Health Planner TELEPHONE: (207)-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ______________________________________________________________________________ CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter 101, Ch II, Section 90, Physician's Services CONCISE SUMMARY: Pursuant to 5 M.R.S.A. Sec 8054, effective December 29, 2008, the Department is increasing the MaineCare reimbursement rate for non-hospital based physician services from 53% to 56.94% retroactive to July 1, 2008. This increase will not include reimbursement for procedures performed by radiologists, radiation oncologists, and pathologists, who currently receive a higher rate of reimbursement. No procedure codes are decreased as a result of this rulemaking. Furthermore, this increase does not apply to other sections of policy within the MaineCare Benefits Manual, Chapter 101. This emergency rule will remain in effect for 90 days while the Department promulgates rules to permanently adopt this rate change. No adverse impact on small businesses is anticipated from adoption of this rule. EFFECTIVE DATE: December 29, 2008 AGENCY CONTACT PERSON: Nicole Rooney, Health Planner TELEPHONE: (207)-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) AGENCY: Department of Health and Human Services, Office of MaineCare Services CHAPTER NUMBER AND TITLE: Maine State Services Manual, Chapter 104, Section 4, Maine Part D Wrap Benefits ADOPTED RULE NUMBER: CONCISE SUMMARY: In order to comply with the federal guidelines that determine the Part D Benefit parameters, the member co-payment for generic drugs has increased from $2.25 to $2.40 per prescription. This emergency rule is required to comply with federal guidelines. The Part D Wrap Benefit covers this co-payment for eligible beneficiaries. The new co-pay amount is reflected in the Appendix to this rule. This rule change is not expected to impose administrative costs on small businesses. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Nicole Rooney, Health Planner AGENCY NAME: Division of Policy ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-4460 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) =-====================================================================================== CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapters II & III, Section 29, Community Support Benefits for members with Mental Retardation and Autistic Disorder CONCISE SUMMARY: The adopted rule eliminates the Behavioral Add On and reduces the rate of the Medical Add On. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter II, Section 21, Home and Community Benefits for members with Mental Retardation or Autistic Disorder CONCISE SUMMARY: The adopted emergency rules reduce rates for Home Support. Also, rates for the Medical Add On for Community Support, Employment Specialist Services and Work Support are being reduced. Additionally, this rule creates an additional level of support for Home Support Shared Living, and Home Support Family Centered Support Model. Also, the Behavioral Add On has been removed from all services. Lastly, Intensive Family Centered Support has been eliminated as a type of Home Support. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Division of Policy and Performance Services ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 21, Home and Community Benefits for members with Mental Retardation or Autistic Disorder CONCISE SUMMARY: The adopted emergency rules reduce rates for Home Support. Also, rates for the Medical Add On for Community Support, Employment Specialist Services and Work Support are being reduced. Additionally, this rule creates an additional level of support for Home Support Shared Living, and Home Support Family Centered Support Model. Also, the Behavioral Add On has been removed from all services. Lastly, Intensive Family Centered Support has been eliminated as a type of Home Support. Members currently receiving Intensive Family Centered Support will continue to receive increased Family Centered Support with the new regulations until the Department makes a determination under the criteria set forth in Section 21, Chapter II, 21.14 Appendix I. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner TELEPHONE: (207)-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081231/1cba7e84/attachment.html