[Provider] Adopted Rules: Physician, Laboratory, Vision, Podiatry, and Medical Imaging Services

[Provider Notification]

This message is to give notice that rules have been adopted for
MaineCare Benefits Manual, 10-144, Chapters II  of Section 90- Physician
Services, Section 55-Laboratory Services, Section 75-Vision Services,
Section 95-Podiatry Services, Section 101-Medical Imaging and Ch III of
Section 90 Physician's Services.  Adopted rules are final and no changes
can be made at this point.

 

CONCISE SUMMARY:  This letter gives notice of a final rule: MaineCare
Benefits Manual 10-144,  Chapters II  of Section 90- Physician Services
and Section 55-Laboratory Services, Section 75-Vision Services, Section
95-Podiatry Services, Section 101-Medical Imaging and Ch III of Section
90 Physician's Services. The Department adopts the increase to the
MaineCare reimbursement rate for non-hospital based physician services
from 53% to 56.94% as of July 1, 2008. Furthermore, the Department is
proposing to remove some prior authorization requirements for services
including but not limited to hyperbaric oxygen therapy, cochlear
implants, circumcision, septoplasty, and skin tag removal.  

 

Finally the Department is adopting changes to Chapter II Section
55-Laboratory Services, Section 75-Vision Services, Section 95-Podiatry
Services, Section 101-Medical Imaging. The Department has amended the
language under the "reimbursement" sections to these areas of policy to
clarify that the increase mentioned above does not apply to these
services.  MaineCare will reimburse the lowest of 53% of 2005 Medicare
rates, the provider's usual and customary or the allowed amount of the
Medicare Part B carrier for these services. Providers can visit the
Office of MaineCare's website for a list of MaineCare covered services
and rates. This rule change clarifies what the current rate is; the rate
is not being decreased.

 

The Department anticipates no impact to small business; however
physicians may need to resubmit claims in order to get the higher
reimbursement. 

 

EFFECTIVE DATE:                                      March 29, 2009 

AGENCY CONTACT PERSON:       Nicole Rooney, Health Planner

AGENCY NAME:                              Division of Policy 

ADDRESS:                                         442 Civic Center Drive

                                                            11 State
House Station

                                                            Augusta,
Maine 04333-0011

TELEPHONE:                                     (207)-287-4460 FAX: (207)
287-9369

                         TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard
of Hearing)

 

The Division of Policy posts all proposed and recently adopted rules
<http://www.maine.gov/bms/rules/provider_rules_policies.htm>  on
MaineCare's website.  This website keeps the proposed rules on file
until they are finalized and until the Secretary of State website is
updated to reflect the changes.  The MaineCare Benefit Manual is
available on-line at the Secretary of State's website
<http://www.maine.gov/sos/cec/rules/10/ch101.htm> .  

 

 

Is your mailing address up to date with MaineCare?  Please keep
MaineCare up to date so your Remittance Statements and checks arrive on
time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

If you would rather not get these e-mails, visit MaineCare's List Serve
Subscription
<http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml>  page
to unsubscribe.

 

This is a one-way communication.  Do not reply to this e-mail.  Your
e-mail will not receive response.  If you have questions, please call
1-800-321-5557.

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://mailman.informe.org/pipermail/provider/attachments/20090410/35c40e16/attachment.html