[Provider] Reminders from the Office of Elder Services

[Provider Notification]

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
<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
<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.

 

 

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