From provider at lists.maine.gov Fri Sep 5 10:05:54 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Sep 2008 10:05:54 -0400 Subject: [Provider] Proposed MaineCare Rule for Private Non-Medical Institution Services Message-ID: ATTENTION: MaineCare Providers of Private, Non-Medical Services This is notice of a proposed rule. Rule Title and Subject MaineCare Benefits Manual, Chapter II, Section 97, Private Non-Medical Institution Services Concise Summary The Department of Health and Human Services is proposing changes to MaineCare Benefits Manual, Chapter II, Section 97, Private Non-Medical Institution Services. This proposed rule will permanently adopt emergency rules currently in place. In this rulemaking, the Department is eliminating language about bedhold days. These rules are intended to achieve a savings of $2,000,000.00 in the general fund for SFY 08-09. Public Hearing September 17, 2008, 2:00 pm 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 28, 2008 Agency Contact Person Patricia Dushuttle Manager, Division of Policy and Performance 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/20080905/c28f98e9/attachment.html From provider at lists.maine.gov Fri Sep 5 10:09:46 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Sep 2008 10:09:46 -0400 Subject: [Provider] MaineCare Proposed Rule for Residential Care Facilities Message-ID: ATTENTION: MaineCare Providers of Residential Care This is notice of a proposed rule for Chapter 115, Principles of Reimbursement for Residential Care Facilities- Room and Board Costs Concise Summary This proposed rule will permanently adopt language in Chapter 115, Principles of Reimbursement for Residential Care Facilities- Room and Board Costs that currently only allows bedhold hold reimbursement when an associated PNMI treatment cost has also been billed under MaineCare. Providers billing for PNMI room and board costs under Chapter 115 (PNMI Appendices C and F only) will still be able to bill up to thirty (30) bedhold days per calendar year when a member is absent from the facility. The codes used for this billing continue to be reimbursed with the billing codes "BL" and "MRBL." This will allow for continued reimbursement of some routine fixed costs that are not eliminated when the member is temporarily absent from the facility. These funds are reimbursed by all state dollars, and are not matched with reimbursement from the federal Medicaid program Public Hearing September 17, 2008 at 1:00 pm 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 28, 2008 Agency Contact Person Patricia Dushuttle Manager, Division of Policy and Performance 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/20080905/e4c96e68/attachment.html From provider at lists.maine.gov Fri Sep 5 10:19:30 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Sep 2008 10:19:30 -0400 Subject: [Provider] MaineCare Adopted Rule for Fluoride Topical Varnish by Physicians Message-ID: ATTENTION: MaineCare Physician Providers with Subspecialties of General or Family Practice, Preventative Medicine, Pediatrics and Internal Medicine This is notice of an adopted rule for the MaineCare Benefits Manual, Chapter II, Section 90, Physician Services Concise Summary The Department has adopted rules to add coverage of application of fluoride topical varnish by physicians with subspecialties of general or family practice, preventative medicine, pediatric, or internal medicine for members under the age of twenty-one (21) who are at high risk for caries. Coverage by physicians will increase access to this service that is already covered when by provided by a dentist. Research shows that provision of this preventative service reduces the need for restorative dental services for children. The changes for Physician Services are in Chapter II only of the MaineCare Benefits Manual. The Department did not adopt the other initiative proposed in this rulemaking that would have increased reimbursement for procedure codes to 61.7% of the current Medicare rate (from 53%). The Department withdrew this proposal as a result of errors in calculations that would have inadvertently decreased reimbursement for some specialty procedures. The Department will immediately propose a fee increase in a separate rulemaking that assures that there are no decreases in current reimbursement rates. The Department does not anticipate any adverse impact on small businesses from this rulemaking. Effective Date September 1, 2008 Agency Contact Person Patty 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/20080905/43f20476/attachment.html From provider at lists.maine.gov Fri Sep 5 10:23:44 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Sep 2008 10:23:44 -0400 Subject: [Provider] MaineCare Final Rule for Primary Care Case Management Fee Increase Message-ID: ATTENTION: All MaineCare Providers of Primary Care Case Management This is notice of the final rule for the MaineCare Benefits Manual, Chapter VI, (Primary Care Case Management) Concise Summary The Final Rule increases the primary care case management fee from $2.50 per member to month to $3.50 per member per month. The rule expands the PCCM eligibility to include those members with Supplemental Security Income (SSI) who are not eligible for Medicare. The Final Rule is effective on August 20 2008, however the changes increasing the primary care case management fee from $2.50 per member per month to $3.50 per member per month is retroactively in effect on July 1, 2008. The Department added language to sub-section 1.08-2 (o) stating that participating physicians must oversee and manage a care plan for patients who have chronic conditions including but not limited to: Chronic Obstructive Pulmonary Disease (COPD), Asthma, Cardiovascular Disease (CVD), depression and/or diabetes. Some MaineCare members will be exempted from participation, including but not limited to those who are hospitalized (inpatient) on the date they are enrolled, those Native American or Alaskan members who by federal authority may voluntarily opt out of the program, and certain foster children. The final rule also states that PCCM providers will no longer be required to manage audiology, speech/language pathology services. The Department has additionally updated language consistent with Chapter I that clarifies care for non citizens. The Department made several other structural, administrative and grammatical changes and updates to make the rule consistent with language in other areas of the MaineCare Benefits Manual (MBM). The Final Rule does not have any adverse impact on small business. Effective Date August 20, 2008 Agency Contact Person Melanie Miller 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/20080905/d25d3072/attachment.html From provider at lists.maine.gov Fri Sep 5 10:13:22 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Sep 2008 10:13:22 -0400 Subject: [Provider] Adopted MaineCare Rule related to Benefits for the Elderly and Adults with Disabilities Message-ID: ATTENTION: MaineCare Providers of Home and Community Benefits This is notice of an Adopted Rule for the MaineCare Benefits Manual, Chapter II, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities. Concise Summary This rule making permanently adopts the proposed language that eliminates requirements for Independent Living Assessments as these are no longer done. In addition, the language that reduces the number of face-to-face care management visits and loosens requirements for home modifications are permanently adopted. Finally, all other minor changes to make the language consistent with the language in the 1915(c) Federal waiver are being adopted. This rule making does not yield any adverse effects on small businesses or municipalities. Effective Date August 23, 2008 Agency Contact Person Alyssa Morrison 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/20080905/e8cf749d/attachment.html From provider at lists.maine.gov Fri Sep 5 13:37:18 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 5 Sep 2008 13:37:18 -0400 Subject: [Provider] Classification Reminder for MaineCare Day Health Service Providers Message-ID: ATTENTION: Day Health Providers are required to obtain correct classification This is a reminder to Day Health Service providers that a correct classification is required for members receiving services under Section 26 of the MaineCare Benefits Manual. Classification is required to ensure claims payment by MaineCare. Classifications should be obtained from the Office of Elder and Adult Services. Obtaining a classification includes an assessment by Goold Health Systems (GHS). MeCMS claims edit logic was updated on June 6, 2008 to enable the claims processing system to look for these classifications on submitted claims. Claims submitted without the correct classification will be denied. Policy surrounding the classification requirement has not changed. Chapter II, Section 26 of the MaineCare Benefits Manual states "26.02-2 Specific Day Health Services Eligibility Requirements (8/05/2005): The member must be assessed by the Department or the Department's authorized agent, using the Department's approved medical eligibility assessment form. A member must require assistance with a combination of activities of daily living and nursing at specific levels in order to meet eligibility for specific levels of care." 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/20080905/b5020d82/attachment.html From provider at lists.maine.gov Mon Sep 15 08:54:24 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 15 Sep 2008 08:54:24 -0400 Subject: [Provider] NPI Update from CMS Message-ID: ATTENTION: All MaineCare Providers who have obtained National Provider Identifiers (NPIs) This message is forwarded from the Centers for Medicare and Medicaid Services and is for health care providers, particularly physicians and other practitioners, who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES). The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners: * Know and maintain their NPPES User Ids and passwords. * Reset their NPPES passwords at least once a year. See the NPPES Application Help page regarding the 'Reset Password' rules. Those rules indicate the length, format, content and requirements of NPPES passwords. * Review their NPPES records in order to ensure that the information reflects current and correct information. Maintaining NPPES Account Information for Safety and Accessibility Health care providers, including physicians and non-physician practitioners, should maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes. Viewing NPPES Information Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways: (1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. * * If the health care provider has forgotten the password, enter the User ID and click the "Reset Forgotten Password" button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID. OR (2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do . The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion. Updating NPPES Information Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf . Need More Information? Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information. Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080915/55748ebd/attachment.html From provider at lists.maine.gov Mon Sep 15 09:17:53 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 15 Sep 2008 09:17:53 -0400 Subject: [Provider] Frequently Asked Questions for Section 65, Behavioral Health Services Message-ID: ATTENTION: All MaineCare Providers of Behavioral Health Services under the new Section 65 Thank you to providers attending training sessions for the new MaineCare Benefits Manual Section 65. Questions asked during these sessions have been gathered for a Frequently Asked Question (FAQ) document. This document is posted to the MaineCare Services web site, within the News and Provider Meetings section, and "News You Can Use" tab. Providers can view it directly by clicking: http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#b ehavhlth Additional questions should be forwarded to the appropriate MaineCare provider relations representative. 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/20080915/f765930a/attachment.html From provider at lists.maine.gov Tue Sep 16 10:08:14 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 16 Sep 2008 10:08:14 -0400 Subject: [Provider] MaineCare Podiatry Changes Effective October 1 Message-ID: ATTENTION: All MaineCare Providers of Podiatry Services To achieve savings as required by the Maine State Legislature, MaineCare has made changes to MaineCare Benefits Manual, Chapter II, Section 90, Physician Services & Section 95, Podiatry Services regarding prior authorization. After an initial visit, all foot and ankle care services will only be covered for a member who meets the following medical eligibility requirements with supporting documentation: 1. Has any illness, diagnosis, or condition that if left unattended may cause loss of function or may risk loss of limb; AND 2. For whom self-care or foot care by a nonprofessional person would be hazardous and pose a threat to the member's condition. Several procedures now require prior authorization. A complete listing is posted on the MaineCare internet and can be found at http://www.maine.gov/bms/member/innerthird/mecms_portal_news.html#podiat ry Also please note that procedure code 28890 - High Energy ESWT, plantar fasciitis, will NO LONGER be a MaineCare covered service as of October 1, 2008. This decision was made after finding the data inconclusive to support the use of ESWT for the treatment of plantar fasciitis. 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/20080916/fda775ba/attachment.html From provider at lists.maine.gov Thu Sep 18 15:27:21 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 18 Sep 2008 15:27:21 -0400 Subject: [Provider] PNMI Update Message-ID: ATTENTION: All MaineCare Private Non-Medical Institutions The attached memorandum is sent on behalf of the Commissioner's Office. 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/20080918/2af2cc3d/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: PNMI Update Memorandum 9-18-08.doc Type: application/msword Size: 441856 bytes Desc: PNMI Update Memorandum 9-18-08.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080918/2af2cc3d/PNMIUpdateMemorandum9-18-08.doc From provider at lists.maine.gov Tue Sep 23 15:27:31 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 23 Sep 2008 15:27:31 -0400 Subject: [Provider] Reminders from the Office of Elder Services Message-ID: ATTENTION: All Home Health Agencies Effective 9/16/08, the Office of Elder Services (OES) is requesting that all home health agencies submit completed MaineCare Home Health Admit/Discharge Forms to OES. Any forms that are not complete will be returned to the agency for corrections. Incomplete forms could potentially delay payment to the home health agency. In addition: * After a consumer has received 120 days of home health services (two certification periods), the agency must obtain prior authorization for additional services. This is accomplished by referring the member for a medical eligibility determination assessment by Goold Health Systems. Fax a referral form to Goold Health Systems (GHS) at 1-800-368-0965 or call GHS at 1-800-609-7893. The referral form and instructions are available on the Office of Elder Services website, http://www.maine.gov/dhhs/beas/medxx_me.htm . * Requests for Psychiatric Medication Services must include the assessment form indicating the member meets the eligibility requirements described in Section 17.02 of the MaineCare Benefits Manual. These requests must also include confirmation of a Global Assessment of Functioning (GAF) score of 50 or less. Services can be authorized for up to one year. (See Section 40.02-4 of the MaineCare Benefits Manual) * Physical therapy services can be provided based on the physician's assessment that the member has rehabilitation potential and will improve significantly in a predictable period. When the member is receiving Physical Therapy and/or Occupational Therapy, one of the items in the right-hand box, in the lower section of the MaineCare Home Health Admit/Discharge Form, must be checked to indicate the circumstances that prompted the need for therapies. These guidelines have been in effect since January 20, 2006 and can be reviewed by clicking on the following link at Admit/Discharge Form Instructions: http://www.maine.gov/dhhs/beas/homehealth/homehealth.htm For more information, contact Sue Pinette with the Office of Elder Services at 287-9227. 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/20080923/b9b33dac/attachment.html From provider at lists.maine.gov Wed Sep 24 09:24:35 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 24 Sep 2008 09:24:35 -0400 Subject: [Provider] Update from the Office of Elder Services Regarding Members Receiving Waiver Services Message-ID: ATTENTION: Home Health Agencies The Office of Elder Services is providing an update to home health agencies that provide services to MaineCare members who are also receiving waiver services. MaineCare members receiving waiver services are subject to cost caps. This can impact payment for home health agency services. When a representative of a home health agency calls the 1-800-321-5557 voice response line to confirm MaineCare eligibility, they should select Option 2 and follow the prompts to speak with a member services representative. They can then confirm if the client/member is classified as currently receiving waiver services. Member services representatives are prepared to give information about waiver services and to assist home health agencies. For more information, please contact Sue Pinette with the Office of Elder Services at 287-9227. 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/20080924/cfbb03e0/attachment.html From provider at lists.maine.gov Mon Sep 29 17:08:39 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 29 Sep 2008 17:08:39 -0400 Subject: [Provider] New MaineCare Rates for Community Support Will Be Effective October 1 Message-ID: ATTENTION: MaineCare MR Waiver Providers under Sections 21 and 29 This is a provider notification for MR Waiver Providers, both Sections 21 and 29, who provide Community Support. There are new rates for this service effective October 1, 2008. As a result providers will need to submit two separate lines on claims for the week ending October 4. One line should contain dates of service September 28 - September 30 and another line for October 1 through October 4, each with appropriate rates. Please see the http://www.maine.gov/bms/rules/provider_mcare_benefit.htm web page for the recently adopted rule. Hard copies of the rule will be mailed out this week. Please contact MaineCare Provider Relations at 1-800-321-5557, Option 8 if you have any 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/20080929/ed0b6d32/attachment.html From provider at lists.maine.gov Mon Sep 29 17:25:45 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 29 Sep 2008 17:25:45 -0400 Subject: [Provider] MaineCare Is Increasing Rates for Ostomy Supplies Message-ID: ATTENTION: MaineCare providers of ostomy supplies MaineCare will increase rates for certain ostomy supplies retroactive to January 1, 2008. Code Description New MaineCare rate Effective 1/1/08 A5061 Pouch drainable 4.69 A4385 Skin barrier 6.30 A4363 Ostomy clamp 2.01 A4409 Skin barrier 7.77 A4425 Ostomy pouch drain 3.58 A4393 Urine pouch 11.34 A4390 Drainable pouch 11.88 A4423 Ostomy pouch for bar with filter 1.86 A4414 Ostomy skin barrier w/o con 6.16 A5063 Drain ostomy pouch with flange 5.52 A5073 Urinary pouch on barrier with flange $7.87 Providers should bill their usual and customary charge. If their usual and customary was higher than MaineCare's previous rates, providers should file adjustments for 2008 claims already filed. Claims yet to be filed will use the new rate as the maximum. Questions? Contact MaineCare Customer Service at 1-800-321-5557. 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/20080929/618bb47e/attachment.html