From provider at lists.maine.gov Tue Jul 1 15:30:26 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 1 Jul 2008 15:30:26 -0400 Subject: [Provider] MaineCare Participation in CMS Payment Error Rate Measurement (PERM) Audit Message-ID: ATTENTION: All MaineCare Providers Over the next year you may be asked to submit medical records for MaineCare Members to a contractor who is conducting an audit of MaineCare eligibility and claims for the federal Center for Medicare and Medicaid Services (CMS). CMS is required to audit each state once every three years. Maine is being audited for federal fiscal year 2008 (October 2007 through September 2008). This audit is part of the Payment Error Rate Measurement program (PERM). PERM was developed by the Centers for Medicare & Medicaid Services (CMS) to comply with the Improper Payments Information Act (IPIA) of 2002. PERM measures improper payments in Medicaid and the State Children's Health Insurance Program (SCHIP) and produces state and national-level error rates for each program. If you are contacted by the contractor collecting samples of MaineCare claims, it is critical for you to submit complete records within 90 days. If records are not submitted on time, or if the records are not complete, Maine will be charged with an error. If the error involves a claim, Maine may have to reimburse the federal government for the federal match. If Maine has to reimburse the federal government, we may seek reimbursement from providers who did not comply with federal law. You will be contacted by telephone. If the contractor is unable to contact you, Maine will be charged with an error. The telephone number the contractor will use is based on the telephone number MaineCare has for you. If you have recently changed your telephone number please contact MaineCare Provider Enrollment by calling 1-800-321-5557, Option 6. A memorandum is attached to this message with further details on the PERM program. This letter is also being mailed to all active MaineCare providers. 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/20080701/d4a60357/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: PERM Letter to Providers.doc Type: application/msword Size: 62976 bytes Desc: PERM Letter to Providers.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080701/d4a60357/PERMLettertoProviders.doc From provider at lists.maine.gov Mon Jul 7 12:22:26 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 7 Jul 2008 12:22:26 -0400 Subject: [Provider] UPDATE on Proposed Changes in Targeted Case Management Message-ID: ATTENTION: MaineCare Providers of Targeted Case Management Services Recently passed legislation by the federal government has delayed the implementation of several proposals by the Centers for Medicare and Medicaid Services (CMS). Among these are the previously proposed changes in Targeted Case Management (TCM) services. Although the bulk of the federal TCM rules are now under a moratorium - there are still some aspects of those revisions that Maine may still need to implement. As a result, MaineCare Services will not proceed, at this time, with its previously proposed TCM rule-making. The current thinking is that changes for targeted case management will be proposed again, at a later time. 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/20080707/77cc115d/attachment.html From provider at lists.maine.gov Tue Jul 8 15:56:35 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 8 Jul 2008 15:56:35 -0400 Subject: [Provider] Online Registration for Provider Training Message-ID: ATTENTION: Behavioral Health Services Providers Online Registration Now Available for Section 65 Training If you have not already registered for a training session on the proposed rule changes for Section 65, you can do so online. Please click on Super Section 65 training registration form to access this. Once you send in a completed registration, you will receive a confirmation e-mail, which you need to print and take with you to the session. Also, please note that these emergency rule changes are not yet posted to the MaineCare web site. A notification listserv message will be sent once they are formally proposed and posted. We look forward to seeing you at a session soon! 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/20080708/c1874e70/attachment.html From provider at lists.maine.gov Wed Jul 9 09:05:20 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 9 Jul 2008 09:05:20 -0400 Subject: [Provider] Adjustment of 2005 Claims Paid at Zero Dollars Message-ID: ATTENTION: MaineCare FQHC and RHC Providers with 2005 Zero Paid Claims On July 10, 2008, MaineCare Services will run a System Initiated Adjustment to reprocess and adjust FQHC and RHC claims that paid at zero dollars during 2005. Excluded from the System Initiated Adjustment will be claims that were billed only for coinsurance and deductible. MaineCare is researching zero paid and incorrectly paid coinsurance and deductible claims for these providers separately. Impacted providers should see these adjustments on your July 23rd and/or July 30th Remittance Advices. If you do not see at least some of the adjustments on your July 23rd RA, please contact your Provider Relations Specialist. MaineCare will be tracking the progress of these adjustments and will be able to determine problems with the specific adjustment or if a billing problem exists with the original claim. 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/20080709/2730c3dc/attachment.html From provider at lists.maine.gov Wed Jul 9 09:23:52 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 9 Jul 2008 09:23:52 -0400 Subject: [Provider] Proposed MaineCare Rule for Chapter II, Section 45, Hospital Services Message-ID: ATTENTION: MaineCare Providers of Physician Administered Drugs Rule Title or Subject: MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services Concise Summary: The proposed changes require hospitals to report NDC drug utilization to the Department for physician administered drugs, often referred to as "j code" drugs. Hospitals designated as "340 B hospitals" will be exempt from this requirement. The US Centers for Medicare and Medicaid Services (CMS) has required that state Medicaid programs have in place a mechanism for collecting National Drug Codes (NDC Codes) on all physician-administered drugs. The purpose of this requirement is to allow states to continue to collect negotiated rebates from drug manufacturers for drugs paid for by Medicaid programs. The proposed rule will require hospitals to submit quarterly utilization reports of the Medicaid Top 20 Physician-Administered Multiple Source Drugs ("j code" drugs), listed at: http://www.cms.hhs.gov/DeficitReductionAct/Downloads/Top20PhysicianAdmin istered.pdf. The Department has determined that a failure to comply with this reporting requirement is a sanction, as defined in MBM, Chapter I, Section I, 1.19. The Department has determined that the sanction it will impose for such failure will be the offset of seven percent (7%) of PIP payments, which is further detailed in the proposed rule. This proposed rule does not have any adverse impact on small business. PUBLIC HEARING: No public hearing is scheduled. DEADLINE FOR COMMENTS: Comments must be received by midnight August 1, 2008. AGENCY CONTACT PERSON: Patricia Dushuttle, Manager, Division of Policy and Performance This proposed rule can be found on the MaineCare Services web site at: http://www.maine.gov/bms/rules/provider_proposed_mcare.shtml 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/20080709/bf8b7f8d/attachment.html From provider at lists.maine.gov Wed Jul 9 09:41:01 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 9 Jul 2008 09:41:01 -0400 Subject: [Provider] Adopted Rule for Community Support Services Message-ID: ATTENTION: All MaineCare Providers of Section 17, Community Support Services Concise Summary: The adopted rules repeal Intensive Community Integration (ICI) Services and prorate reimbursement of partial month of Assertive Community Treatment (ACT) required by the adoption of the Supplemental Budget L.D. 2289 as P.L. 2007, c. 539, Section A-1 and Governor's Change Package. 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. Effective Date: July 1, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner The adopted rule is posted to the MaineCare Services web site and can be found at: http://www.maine.gov/bms/rules/prov_recently_adopted.shtml 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/20080709/74eb37b3/attachment.html From provider at lists.maine.gov Wed Jul 9 09:45:47 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 9 Jul 2008 09:45:47 -0400 Subject: [Provider] Adopted MaineCare Rule for Section 21, Home and Community Benefits Message-ID: ATTENTION: MaineCare Providers of Home and Community Benefits for Members with Mental Retardation or Autistic Disorder Concise Summary: This rule permanently adopts major substantive rules approved by the Maine State Legislature and currently in effect by emergency rule. The final major substantive adopted rules specify HIPAA compliant procedure coding and standardized rates for the services detailed in Chapter II. Effective Date: June 15, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner The adopted rule is posted to the MaineCare Services web site and can be found at: http://www.maine.gov/bms/rules/prov_recently_adopted.shtml 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/20080709/cb848bd1/attachment.html From provider at lists.maine.gov Thu Jul 10 14:47:32 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 10 Jul 2008 14:47:32 -0400 Subject: [Provider] Adopted MaineCare Rule for Section 46, Psychiatric Hospital Services Message-ID: ATTENTION: All Providers of "Katie Beckett" Services Concise Summary: This rule revises and updates Psychiatric Hospital Services policy. The rule tightens eligibility criteria for children receiving MaineCare eligibility solely through "Katie Beckett" eligibility to assure that only those children with Severe Emotional Disturbance, who would otherwise require institutional level of care, as required by 42 U.S.C. ?1396a(e)(3) become eligible for the intensive behavioral health services described in this Section. That new language is expected to result in only children who would otherwise require the level of care provided in an institution being deemed eligible through Katie Beckett. The rule provides definitions used in medical eligibility determination, require the diagnosis of a mental health clinician and documentation of functional need for these services, and detail the process for evaluation and reassessment of eligibility. The rule adds requirements for registration, central enrollment, and utilization review of all services reimbursed under this Section, to be performed by the Department or its Authorized Agent. The rule also removes some sections duplicated in other MaineCare or licensing rules and makes numerous technical corrections and updates. This rule is not expected to have an adverse impact on small business. This rule change is expected to save approximately $2.2 million per SFY ($813,418 general funds, $1,454,582 general funds) due to stricter eligibility requirements. Effective Date: July 1, 2008 Agency Contact Person: Patricia Dushuttle This rule is posted on the MaineCare Services web site and can be found by choosing the link: http://www.maine.gov/dhhs/bms/rules/prov_recently_adopted.shtml 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/20080710/6cd52b9f/attachment.html From provider at lists.maine.gov Thu Jul 10 14:53:24 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 10 Jul 2008 14:53:24 -0400 Subject: [Provider] Adoption of Rule for Chapter III, Section 50, ICF-MR Services Message-ID: ATTENTION: All Providers of Services under Section 50, ICF-MR Concise Summary: The federal Tax Relief and Health Care Act, P.L. 109-432, Section 403, modified the maximum allowable level for health care provider taxes that may be applied in Medicaid from 6 percent to 5.5 percent. This rule revises and updates one section of ICF-MR policy in order to comply with that law. ICFs-MR subject to the Health Care Provider Tax defined in State law 36 M.R.S.A., Chapter 373, will have the tax treated as an allowable fixed cost. The proposed rule does not impose an economic burden on small business, municipalities or counties. Effective Date: July 1, 2008 Agency Contact Person: Patricia Dushuttle This rule is posted to the MaineCare Services website and can be found by choosing the link: http://www.maine.gov/dhhs/bms/rules/prov_recently_adopted.shtml 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/20080710/71131391/attachment.html From provider at lists.maine.gov Thu Jul 10 14:58:38 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 10 Jul 2008 14:58:38 -0400 Subject: [Provider] MaineCare Emergency Rule-Making for Chapter II, Section 2, Adult Family Care Home Services Message-ID: ATTENTION: MaineCare Providers of Adult Family Care Home Services Concise Summary: The Department has determined that the immediate adoption of these rules is necessary to avoid an immediate threat to public health, safety or general welfare. Emergency adoption of this rule will assure access to Adult Family Care Home services for MaineCare members who otherwise may require immediate placement in an institutional setting in order to receive medically necessary services. These emergency rules 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 Housing Program: Level III Residential Care Facility. Those facilities with more than six beds will require licensure as an Assisted Housing Program: Level IV Residential Care Facility. These emergency rules will remain in effect for ninety days. The Department will permanently adopt these changes through a proposed rulemaking, and will hold a public hearing as part of that separate rulemaking. Effective Date: July 1, 2008 - September 28, 2008 Agency Contact Person: Patricia Dushuttle This rule has been posted to the MaineCare Services web site and can be found by choosing this link: http://www.maine.gov/dhhs/bms/rules/prov_emergency.html 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/20080710/87bcfefb/attachment.html From provider at lists.maine.gov Tue Jul 15 09:15:31 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 15 Jul 2008 09:15:31 -0400 Subject: [Provider] MaineCare Provider Services All Day Training on July 25 Message-ID: ATTENTION: All MaineCare Providers On Friday July 25, the MaineCare Provider Services Office at 1-800-321-5557 Option 9 will be closed for the day. This is so that staff may participate in an all day training seminar. Please remember that you can access eligibility and claims data by: 1- calling the Interactive Voice Response system at 1-800-321-5557 Option 2 and /or 1-800-452-4694 2- signing on to the claims portals on the OMS website at: http://www.maine.gov/dhhs/bms/member/innerthird/temp_prov_portal.htm Providers can also choose to call 1-800-321-5557 Option 8 for immediate assistance. We will resume our normal business hours at 8:00 am on Monday, July 28. Thank you. 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/20080715/722434fd/attachment.html From provider at lists.maine.gov Tue Jul 15 11:47:55 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 15 Jul 2008 11:47:55 -0400 Subject: [Provider] MaineCare Enrollment of Certified Alcohol and Drug Counselors Message-ID: ATTENTION: MaineCare Substance Abuse Agency Providers MaineCare is making changes to billing for services provided by Certified Alcohol and Drug Counselors (CADC's) employed by Substance Abuse Agencies. As part of these changes, MaineCare will require providers to enroll all CADC's as servicing providers. A servicing provider enrollment form is attached for this purpose. MaineCare already requires agencies to enroll all Licensed Alcohol and Drug Counselors (LADC's) as servicing providers. If a Substance Abuse Agency has any LADC's who are not enrolled as servicing providers, forms should be completed for those servicing providers at this time. The completed form and copy of the CADC license should be sent to: Provider Enrollment MaineCare Services 442 Civic Center Drive #11 State House Station Augusta, Maine 04333 These forms must be returned and the servicing provider associated with the agency billing number prior to billing for services provided on or after August 1. Agency providers will also need to have the CADC servicing provider number to include on their claim form when billing for services provided by the CADC. Please contact MaineCare Customer Service at 1-800-321-5557, Option 6 if you have any questions on enrolling servicing providers. 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/20080715/b3d599a6/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: service provider application (2).doc Type: application/msword Size: 66048 bytes Desc: service provider application (2).doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080715/b3d599a6/serviceproviderapplication2.doc From provider at lists.maine.gov Fri Jul 18 12:16:55 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 18 Jul 2008 12:16:55 -0400 Subject: [Provider] Updated Information on Primary Care Physician Rate Increases Message-ID: ATTENTION: MaineCare Physicians This message updates previous communication related to the additional $8.3 million for reimbursement to MaineCare physicians, requested by the Governor and voted on by the Maine Legislature. The original updated fee schedule contained some errors in calculation. We now calculate that the $8.3 million will allow a fee increase from 53% to 56.4% of the 2008 Medicare fee schedule. This is a 6.5% increase in the fee table. In addition, the increase in the primary care case management fee from $2.50 to $3.50 per member per month remains. It is necessary for us to change certain Maine legal rules in order to change our physician fees. That process will take several months in order to fulfill legal requirements to change those rules. Therefore, we cannot make fee schedule adjustments until fall, 2008. Please be assured that we will adjust impacted fees retroactive to July 1, 2008 and will issue checks to adjust payments. It will not be necessary for physicians to re-bill any claims. The complete text of a letter on this topic from Tony Marple, MaineCare Services Director can be found at the link below. An updated fee schedule is also posted there. http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#p rim 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/20080718/af59646c/attachment.html From provider at lists.maine.gov Mon Jul 21 08:15:50 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 21 Jul 2008 08:15:50 -0400 Subject: [Provider] Training Day for MaineCare Provider Services, Option 9 Message-ID: ATTENTION: All MaineCare Providers On Friday July 25, the MaineCare Provider Services Office at 1-800-321-5557 Option 9 will be closed for the day. This is so that staff may participate in an all day training seminar. Please remember that you can access eligibility and claims data by: 1- calling the Interactive Voice Response system at 1-800-321-5557 Option 2 and /or 1-800-452-4694 2- signing on to the claims portals on the OMS website at: https://www.maine.gov/dhhs/bms/member/innerthird/temp_prov_portal.htm Providers can also choose to call 1-800-321-5557 Option 8 for immediate assistance. We will resume our normal business hours at 8:00 am on Monday, July 28. Thank you. 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/20080721/4e70e9bc/attachment.html From provider at lists.maine.gov Wed Jul 23 20:20:56 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 23 Jul 2008 20:20:56 -0400 Subject: [Provider] Update from APS Healthcare Message-ID: ATTENTION: MaineCare Providers working with the Administrative Services Organization The APS Healthcare Service Grid is being revised effective 8/1/08. The Provider Update explaining the revisions to the Service Grid is posted at this link: http://www.qualitycareforme.com/MaineProvider_Update080108a.htm The revised Service Grid is posted at this link: http://www.qualitycareforme.com/documents/provider_providermanual_servic egrid.pdf Another Provider Update explaining the new, simplified APS CareConnection review requirements for Outpatient and Medication Management Services is posted at this link: http://www.qualitycareforme.com/MaineProvider_Update080108b.htm The simplified Outpatient/Med Management Only Continued Stay Request Form is posted at this link: http://www.qualitycareforme.com/MaineProvider_ProviderManual.htm What does this mean for providers? In response to MaineCare policy changes, procedure codes have changed for a number of services including Outpatient Therapy and Medication Management. The Provider Update explains the process to re-register certain services. In addition, PNMI "Bed Hold" or "Leave Days" procedure codes have been removed from the Service Grid. Outpatient and Med Management providers now have a simplified Continued Stay Review request process in APS CareConnection. Please review the updates to see if the changes apply to you and your program. What does this mean for MaineCare Members? MaineCare Members should ask their provider if any of these changes impact their services. These changes in the Service Grid will not affect members. Members can call the APS Healthcare Member Services Liaison (Simonne Maline) at 1-866-521-0027 ext. 4915 if they have questions about these changes. 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/20080723/6680a4e6/attachment.html From provider at lists.maine.gov Wed Jul 23 20:29:58 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 23 Jul 2008 20:29:58 -0400 Subject: [Provider] Reminder for Billing Co-Insurance and Deductibles after Medicare Message-ID: ATTENTION: All Providers Who Bill for Co-Insurance and Deductibles after Medicare It has come to our attention that some providers have not yet finished submitting their coinsurance and deductible claims. This may be because they are waiting for MaineCare to process "crossover" claims electronically. That functionality is not now available. So providers who want to be reimbursed for these types of claims MUST submit them on paper. Providers who have outstanding claims to file are asked to submit them by September 12, 2008. Special Reminders: * Attach the Explanation of Medicare Benefits (EOMB), unless you are billing for physician or APRN services. Claims for these two provider types only require an EOMB when billing for coinsurance and deductibles that exceed $200.00, or when billing for services that have been denied by Medicare and are covered by MaineCare. * When billing on the new CMS1500 claim form, providers should not combine coinsurance / deductible charges with Medicare denied charges. Use one claim form for billing coinsurance / deductible charges, and a separate claim for Medicare denied charges. This message does not pertain to Maine hospital providers. MaineCare is pursuing a work-around solution that will not require these claims to be processed through MeCMS. Additional information will be shared as details become available. Billing instructions can be found on the MaineCare website at: http://www.maine.gov/bms/providerfiles/provider_billing_manuals.htm Please contact MaineCare Customer Service at 1-800-321-5557, Option 8 with 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/20080723/07eee15a/attachment.html