[Provider] Clarification of Billing Instructions for Transportation Services Related to Sections 21 and 29

[Provider Notification]

ATTENTION:            All MaineCare Providers of Community Support Transportation

(formerly known as Day Habilitation Transportation)

 

There has been some discussion regarding the billing for transportation related to services under the Section 21 and 29 Waivers.   The Department is issuing this communiqué to clarify the billing instructions for transportation services.

 

One condition of the Centers for Medicare and Medicaid Services (CMS) Waivers is that the Waiver must be budget neutral.   It cannot cost the federal government more for the Waiver than it would have cost without the Waiver.   CMS requires states to accurately track and separate regular MaineCare expenses from Waiver expenses to demonstrate that the budget neutrality requirement is met.   In addition, services that are covered separately by MaineCare must be reimbursed under the applicable section of the MaineCare manual and may not be reimbursed as a Waiver service.  And finally, the Department must ensure that overall costs do not increase as a result of this transition.  

 

For these reasons, transportation provided to individuals who receive services under Sections 21 and 29 which are covered under Section 113 must be reimbursed under Section 113.  In addition, we believe that there are inequities in the rates currently being paid for transportation to Community Support Services, and that those inequities must be addressed in conjunction with the other changes being implemented.    

 

The following provisions will apply to billing and reimbursement for transportation to and from Community Support services, effective December 30, 2007 for Section 21 and January 1, 2008 for Section 29:   

 

 

*	For transportation services to and from Community Support Services that are currently billed under Section 113 using the T017-T020 codes, providers should continue to bill using those codes during the interim period. 

 

*	For transportation services other than T017-T020 that are billed under Section 113, providers should use the applicable "full service provider" codes.  The T017-T0120 codes may not be used to bill for these services.  Providers who are currently full service providers and do not have an established base rate should contact Rich Lawrence at 287-4875 to have a base rate established.  

 

*	Transportation services that are 21 and 29 Waiver only transportation services (not covered under Section 113) should be billed using the T2003 code. 

 

*	To eliminate the inequities that exist in reimbursement for these transportation services, the Department will initiate the necessary procedures to end separate rates for Section 113 transportation to Community Support Services, and to reimburse those services at the same rates that apply to all other transportation services reimbursed by MaineCare under Section 113.  We expect to propose this change in early February 2008.

 

*	Please note that Section 113 requires a provider to be a full service transportation provider to be reimbursed for services under Section 113.  Providers must meet all of the performance and other requirements including verification of driving records, insurance, reporting, auditing, cost-efficiency, etc.  These requirements are detailed in Section 113.06-7, and are intended to ensure that there is a network of safe, reliable, accessible and well-coordinated transportation resources to meet the needs of MaineCare members throughout the State.  The regional transportation providers have systems in place to meet these requirements.  

 

*	Providers who are not currently full service transportation providers and want to bill directly for services must meet all of the conditions under Section 113 for full service providers.  Additional information can be obtained from MaineCare Customer Service's Provider Enrollment Unit at 1-800-321-5557, Option 6.  As an alternative to direct billing, Community Support Service providers who provide their own transportation services may consider operating as a subcontractor of the regional transportation provider.  This will promote effective coordination of resources and performance management systems.  

 

 

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

 

 

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