[Provider] Emergency Rule Proposal: Section 45, Hospital Services

[Provider Notification]

An emergency rule, MaineCare Benefits Manual, Chapter III Section 45
Hospital Services, was adopted February 1, 2009 and was repealed on
February 21, 2009.  A new emergency rule replaced it effective February
21, 2009.  This is notice of the new emergency rule.  

 

The U.S. Centers for Medicare and Medicaid Services' (CMS) approval is
required before this rule can be permanently adopted.  

 

 

AGENCY:  Department of Health and Human Services, Office of MaineCare
Services

 

CHAPTER NUMBER AND TITLE:  MaineCare Benefits Manual, Chapter III,
Section 45, Hospital Service

 

ADOPTED RULE NUMBER:  

 

CONCISE SUMMARY:  The Fiscal Year 2009 Emergency Supplemental Budget,
deappropriated funds to reduce MaineCare reimbursement for
hospital-based physician services to provide for a rate as close to 70%
of the Medicare reimbursement rate as the Department determines can be
funded with the resources used for physician reimbursement, as adjusted
by the Supplemental Budget, which reduced the reimbursement by
$1,947,490 state dollars, effective February 1, 2009.  P.L. 2009, ch. 1.


 

On February 1, 2009, the Department adopted emergency rules which
reduced reimbursement for both hospital-based inpatient and outpatient
physicians.  Since February 1, 2009, the Department has determined that
the February 1st emergency rule must be repealed because upon further
review, the Department determined that it would be less administratively
burdensome on hospitals to limit the impact to non-emergency
hospital-based outpatient physician services only, rather than to all
hospital-based physicians, within the required savings of $1,947,490
state dollars.  Accordingly, the Department is repealing the February 1,
2009 emergency rules and will be adopting, simultaneously, these
emergency rules, which are being adopted effective February 21, 2009.  

 

Hence, in accordance with P.L. 2009, ch. 1, the Department is adopting
these emergency regulations, with an effective date of February 21,
2009, which will reduce reimbursement for hospital-based physician
services as follows:  non-emergency hospital-based outpatient physician
rates at acute care non-critical access hospitals, acute care critical
access hospitals and hospitals reclassified to a wage area outside
Maine, will be reduced to 46.21% of non-emergency hospital-based
outpatient physician costs.  The rate of 46.21% is the closest to 70% of
the Medicare reimbursement rate that the Department could fund with the
resources used for physician reimbursement, as adjusted by the
Supplemental Budget, which reduced the reimbursement by  $1,947,490 of
state dollars.  Prospective Interim Payments (PIPs) will be lowered in
an amount corresponding to the anticipated non-emergency hospital-based
outpatient physician payment reductions.  

 

See  http://www.maine.gov/bms/rules/provider_rules_policies.htm for
rules and related rulemaking documents.

 

EFFECTIVE DATE:                          February 21, 2009 

 

AGENCY CONTACT PERSON:       Bob Kohl, Health Planner

      AGENCY NAME:                        Division of Policy and
Performance

      ADDRESS:                                   442 Civic Center Drive

                                                            11 State
House Station

                                                            Augusta,
Maine 04333-0011

      TELEPHONE:                              (207)-287-6124   FAX:
(207) 287-9369

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

 
_______________________________________________________________________
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 Page
<http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml>  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
call1-800-321-5557.

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://mailman.informe.org/pipermail/provider/attachments/20090227/9e6f4f18/attachment.html