[Provider] MaineCare Final Rule for Primary Care Case Management Fee Increase

[Provider Notification]

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.

 

 

 

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