[Provider] Adopted MaineCare Rule for Section 46, Psychiatric Hospital Services

[Provider Notification]

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.

 

 

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