From provider at lists.maine.gov Wed Jul 1 12:30:14 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 1 Jul 2009 12:30:14 -0400 Subject: [Provider] Updates to MIHMS Provider Re-enrollment Message-ID: ATTENTION: MaineCare Providers of Educational Related Services and Free Standing Case Management The assigned provider re-enrollment cycles have changed for School-based rehabilitation providers (educational-related services) and targeted case management providers (case management providers that provide only targeted case management services). This is due to pending revisions to MaineCare policy. Provider re-enrollment is required for all current MaineCare providers who wish to continue submitting claims and receiving payments once the new claims management system, known as Maine Integrated Health Management Solution (MIHMS) becomes operational in 2010. School-based rehabilitation providers will now re-enroll in Cycle 3 (not Cycle 1). Free-standing case management providers will also re-enroll during Cycle 3 (not Cycle 2). The overview re-enrollment schedule posted on the MaineCare web site will be updated to reflect these changes. Also, all providers will receive letters inviting them to re-enroll between the dates of their assigned cycle. MIHMS questions can be forwarded to MaineCare2010.dhhs at maine.gov 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 Listserv Subscription 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/20090701/c09fc53f/attachment.html From provider at lists.maine.gov Thu Jul 2 09:17:12 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 2 Jul 2009 09:17:12 -0400 Subject: [Provider] Durable Medical Equipment providers - new contract for incontinent supplies Message-ID: ATTENTION: Durable Medical Equipment Providers - Invacare Contract After a competitive bid process for incontinent supplies, MaineCare has awarded the contract to Invacare. Invacare has served MaineCare members since 2005. As of August 1, 2009, the new contract will begin and offer lower rates. No other terms and conditions will change. New rates will be sent to you in mid-July. If you have questions, please feel free to e-mail Jennifer Cook or call her at 287-2705. 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 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/20090702/0b6c76b5/attachment.html From provider at lists.maine.gov Thu Jul 2 11:04:04 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 2 Jul 2009 11:04:04 -0400 Subject: [Provider] Adopted Rules: Medical Supplies and Durable Medical Equipment Section 60 Message-ID: This message is to give notice that rules have been adopted for Ch. 101, MaineCare Benefits Manual, Chapter II, Section 60, Medical Supplies and Durable Medical Equipment Adopted rules are final and no changes can be made at this point. CONCISE SUMMARY: The adopted rules reflect changes to repeal and replace Section 60 in order to clarify the policy and to achieve legislatively mandated cost savings. Proposed changes include new language under Limitations, additional prior authorization requirements, and new language to clarify that items procured under a contract with the Department must be purchased, billed and reimbursed according to the terms of the contract. This Section has been totally replaced due to extensive formatting changes, including a thorough restructuring of the Appendix. Changes made to the Section 60 proposed rule based on the State budget include: increasing the markup of the acquisition cost of DME to 40% from 30%, and DME providers must deduct any prompt payment discounts when determining the acquisition cost of DME. Several additional changes were made to clarify the Section 60 proposed rule due to comments received and legal review, such as; sleep studies for CPAP and Bi-Pap done within the last three (3) years will be accepted; limits for incontinent supplies for members under 21 were removed; and the time to obtain a written prescription for a Power Mobility Device was changed to 45 days. The adopted rule does not impose an economic burden on municipalities or counties. The adopted rules are not expected to increase reporting, record keeping, or other administrative costs or skills necessary for reporting or recording for small businesses. See http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents. EFFECTIVE DATE: July 1, 2009 AGENCY CONTACT PERSON: Darrell S. Wood, Health Planner AGENCY NAME: Division of Policy and Performance ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-6348, 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 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 . 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 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/20090702/c749aeab/attachment.html From provider at lists.maine.gov Thu Jul 2 16:49:50 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 2 Jul 2009 16:49:50 -0400 Subject: [Provider] DME Update Message-ID: ATTENTION: MaineCare Durable Medical Equipment Providers The Department did not intend to adopt section 60.06 Restricted Services # 11 which requires Prior Authorization (PA) for incontinent supplies for members over age 21. We are waiving these PA requirements; your claim will not require a PA number. The adopted rule does put limits on incontinent supplies for members over age 21. Any request for supplies beyond the limits will require a PA. This section will be corrected in an emergency rule making. More information will follow next week. We apologize for any inconvenience. 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 Listserv Subscription 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/20090702/3e085cca/attachment.html From provider at lists.maine.gov Tue Jul 7 13:05:58 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 7 Jul 2009 13:05:58 -0400 Subject: [Provider] Proposed Rules: 10 MaineCare services Message-ID: Below are 10 rules which were recently proposed. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. * Ambulatory Care Clinic Service * Ambulatory Surgical Center Services * Chiropractic Services * Community Benefits for Members with Mental Retardation and Autistic Disorder. * Developmental and Behavioral Evaluation Clinic Services * GeneticTesting and Clinical Genetic Services * Home and Community Benefits for Members with Mental Retardation or Autistic Disorder. * Pharmacy Services * Private Duty Nursing and Personal Care Services * STD Screening Clinic Services Rule Title or Subject: MaineCare Benefits Manual, Chapters II & III, Section 3, Ambulatory Care Clinic Services Back to top Concise Summary: The Department intends to transition to a new information system, MIHMS in 2010, with 30 days notice to providers. Upon implementation of MIHMS, the Department proposes to delete the current local billing codes in Chapter III, Table 1, and replace them with the codes in Chapter III, Table 2 to become compliant with Federal HIPAA regulations. Further the Department proposes requiring providers to document services provided, including the type of visit, diagnoses and procedures on the CMS 1500 form. Public Hearing: July 16, 2009, 11:00 AM Conference Room #3 Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before Friday July 10, 2009. Deadline for Comments: Comments must be received by midnight July 27, 2009. Agency Contact Person: Derrick Grant Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9362 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) =============================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services Back to top Concise Summary: The Office of MaineCare Services is proposing changes to the MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services. The Department proposes updating the policy to reflect CMS changes. The Department proposes several other structural and grammatical changes within this rulemaking. Public Hearing: A public hearing will not be held for this rulemaking unless 5 or more individuals request one. Deadline for Comments: Comments must be received by midnight July 24, 2009. Agency Contact Person: Derrick Grant, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9370 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ==================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapter III, Section 21, Home and Community Benefits for Members with Mental Retardation or Autistic Disorder. Back to top Concise Summary: The proposed major substantive rule provisionally adopts amendments to certain rates paid to providers of home and community based services. The new rates were adopted on and emergency basis, effective July 1, 2009, pursuant to the budget act. The change in rates is mandated by the Legislature. The budget initiative requires that rates be reduced by 6%; however, the budget initiative specifies that the reduction is from rates effective in December 2008. In addition, changes to billing codes are proposed to comply with federal coding requirements. The coding changes will take effect when the Department's new claims processing system becomes operational, expected to occur in February, 2010. Providers will receive 30 days notice of the effective date of the coding changes. Public Hearing: July 30, 2009, 1-3 PM Conference Room # 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before July 18, 2009. Deadline for Comments: Comments must be received by midnight August 9, 2009 Agency Contact Persons: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ==================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapters II and III, Section 23, Developmental and Behavioral Evaluation Clinic Services Back to top Concise Summary: The Department proposes to repeal MaineCare Benefits Manual, Chapter II and III, Section 23, Developmental and Behavioral Evaluation Clinic Services. The evaluation and assessment services covered in this section can be provided under other sections of the MaineCare Benefits Manual governing specific services, e.g., psychological testing, occupational therapy assessments, speech and language evaluations, etc. In addition, the current billing codes employed under ? 23 do not comply with federally mandated coding requirements. Providers will be directed to use standardized HIPAA compliant codes for the specific services they provide. Public Hearing: July 29, 2009, 8:00 am Conference Room 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, Maine Any interested party requiring special arrangements to attend the hearing must contact the agency contact person below before July 15, 2009. Deadline for Comments: Comments must be received by midnight August 8, 2009 Agency Contact Person: Melanie Miller, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-4459 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ==================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapter III, Section 29, Community Benefits for Members with Mental Retardation and Autistic Disorder. Back to top Concise Summary: The proposed rule merely adds a modifier to the procedure code for transportation services. It will become effective at the time the Department's new claims payment system becomes operational, expected to occur in February 2010. Public Hearing: The Department is not holding a public hearing on this rule change. If five or more people submit a written request for a hearing, a hearing will then be scheduled at a later date. Deadline for Comments: Comments must be received by midnight August 14, 2009 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ==================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapters II & III, Section 62, Genetic Testing and Clinical Genetic Services Back to top Concise Summary: The Department gives notice of a proposed repeal of a rule: MaineCare Benefits Manual, Chapters II & III, Section 62, Genetic Testing and Clinical Genetic Services. The Department is repealing this section of the MaineCare Benefits Manual to simplify the billing for this service and to repeal outdated clinical provisions currently in Section 62, Genetic Testing and Clinical Genetic Services. Currently the majority of genetic services are being billed under Sections 90 and 55 of the MaineCare Benefits Manual. Providers who were currently billing under Section 62 will now bill under Sections 90, Physicians Services and 55, Laboratory Services, as appropriate. No services are being reduced as a result of this rulemaking. Public Hearing: A public hearing is not being schedule for this rulemaking unless five or more people request a hearing. Deadline for Comments: Comments must be received by midnight August 7, 2009 Agency Contact Person: Nicole Rooney, Comprehensive Health Planner Agency Name: Office of MaineCare Services 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 or Hard of Hearing) ==================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services Back to top Concise Summary: The Department of Health and Human Services is proposing changes to Chapter II, Section 80, Pharmacy Services. The proposed rule edits the definition of the Maine Maximum Allowable Cost as a result of savings initiatives. The changes will allow Maine to MAC cost of items such as diabetic supplies and Specialty drugs. This rule also removes language in 80.05-3 (b), which states that reimbursement for B-12 for documented pernicious anemia or megaloblastic anemia drugs will be made only for the conditions described and only when the prescriber has written the diagnosis on the prescription. The Department will no longer cover these medications unless prior authorization is awarded. Finally, the Department is adding section 80.04-3, Academic Detailing Committee to comply with 22 M.R.S.A ? 2685. The Committee members will be appointed by the Department and will provide evidence based education, outreach, improve quality measures and encourage better communication between the Department and health care professionals to reduce health complications and unnecessary cost associated with inappropriate drug prescribing. The Department also made other structural, administrative, grammatical and clarifying changes within this rulemaking. Public Hearing: A public hearing is not being scheduled for this rulemaking unless five or more people request a hearing. Deadline for Comments: Comments must be received by midnight July 30, 2009 Agency Contact Person: Nicole Rooney, Comprehensive Health Planner Agency Name: Office of MaineCare Services 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 or Hard of Hearing) ==================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapters II and III, Section 96, Private Duty Nursing and Personal Care Services Back to top Concise Summary: The Department proposes changes to Chapters II and III of Section 96, Private Duty Nursing and Personal Care Services in order to begin permanent adoption of the emergency rule that takes effect July 1, 2009. Specifically, this proposed rule includes adding two definitions to the rule. This rule making also proposes a new level of eligibility, level IX, for those MaineCare eligible members who require medication administration services and assistance with ADLs or IADLs. As a result of these new criteria, Chapter III is also being proposed to include two new codes that will provide the ability for qualified providers to bill for such services. In addition to these changes, the Department proposes to update the names of the Departmental Offices that are mentioned in the rule. Other minor technical and grammatical changes are also proposed. Public Hearing: August 6, 2009 at 10 AM Conference Room # 1A and B Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before July 30, 2009. Deadline for Comments: Comments must be received by midnight August 16, 2009. Agency Contact Person: Alyssa Morrison, Health Planner Agency Name: Office of MaineCare Services Address: 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) =================================================================== Rule Title or Subject: MaineCare Benefits Manual, Chapters II and III, Section 150, STD Screening Clinic Services Back to top Concise Summary: The proposed changes to this section increase the reimbursement rate to providers, add information on clinical record keeping, and update the policy language. The local code is replaced by a HIPAA compliant code. Estimated increase in annual aggregate expenditures: $1,630.00 per FY. Anticipated Effective Date: MARCH 1, 2010 Public Hearing: August 11, 2009 1:00 PM Conference Room 3 Department of Health and Human Services 442 Civic Center Drive Augusta, ME 04330 Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below no later than August 4, 2009. Deadline for Comments: Comments must be received by midnight August 21, 2009. Agency Contact Person: Derrick Grant Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-6427 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ____________________________________________________________________________ The Division of Policy posts all proposed and recently adopted rules 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 . 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 ListServ Subscription 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/20090707/6bec4b2f/attachment.html From provider at lists.maine.gov Tue Jul 7 16:23:14 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 7 Jul 2009 16:23:14 -0400 Subject: [Provider] Emergency rules: various sections Message-ID: This message is to give notice that these emergency rules have recently been adopted. Emergency rules will be effect for 90 days at which time the Department will adopt the permanent rule. Community Support Services Home and Community Benefits for Members with Mental Retardation or Autistic Disorder Hospital Services Psychiatric Hospital Services, Chapter II Principles of Reimbursement for Nursing Facilities Private Duty Nursing and Personal Care Services Speech and Hearing Services Chapter Number And Title: 10-144, CH 101, MaineCare Benefits Manual, Chapters II & III, Section 17, Community Support Services Concise Summary: These emergency rules specify a new level of service called Community Rehabilitation Services to provide community support to qualifying individuals with an assessed need for that level of service. The rules replace the Global Assessment Functioning (GAF) scale with the Level of Care Utilization System (LOCUS) as a component of eligibility criteria for Community Support Services. The rules specify the services and delivery requirements for ACT clients. The rules provide HIPAA-compliant billing codes for use in the Maine Integrated Health Management Solution (MIMHS) system when it is implemented. The rules also include some formatting and other technical changes to improve clarity. Effective Date: 7/1/09 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Division of Policy and Performance Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ======================================================================== Chapter Number And Title: MaineCare Benefits Manual, Chapter III, Section 21, Home and Community Benefits for Members with Mental Retardation or Autistic Disorder Concise Summary: The emergency adoption of this major substantive rule specifies new rates that are effective July 1, 2009. The change in rates is mandated by the Legislature. The budget initiative requires that rates by reduced by six (6) %; however, the budget initiative specifies that the reduction is from the rates that were effective in December 2008. Effective Date: 7/1/09 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Division of Policy and Performance Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing ======================================================================== =========== Chapter Number And Title: MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services Concise Summary: The Department has determined that the immediate adoption of these rules is necessary to assure that initiatives directed by the Maine State Legislature are immediately implemented to achieve required hospital expenditure savings in the budget law, per PL 2009, ch. 213, part CC. The Legislature authorized the Department to do emergency rulemaking on or before December 31, 2009, for provisions over which the Department has subject matter jurisdiction, without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety or general welfare (P.L. 2009, ch. 213, Part RRRR). Effective July 1, 2009 the Department will reduce hospital reimbursement. For acute care non-critical access hospitals, inpatient discharge rates (except for those from psychiatric units) will be reduced 6.7% and reimbursement for outpatient services will decrease to 83.8% of costs. For critical access hospitals and hospitals reclassified to a wage area outside Maine, reimbursement for inpatient and outpatient services will be reduced to 109% of costs. For all acute care hospitals, including critical access, hospital based physician reimbursement will be decreased from 100% to 93.3% of allowable costs for inpatient non-emergency physicians, to 93.4% of costs for inpatient emergency physicians and to 83.8% of costs for outpatient non-emergency physicians. If approved by CMS, the Department caps the PIP payment so that the total payment to all hospitals is not less than 80%. In addition, these rules eliminate the COLA adjustment for SFY's 2010 and 2011 for acute care non-critical access hospitals for inpatient discharge rate and for psychiatric unit discharge rates. The Department estimates that this reimbursement reduction will result in a decrease of $25,554,918 in annual aggregate (state and federal Medicaid funds) expenditures for settled hospital expenditures. This emergency rulemaking will not yield any new administrative burdens or compliance-related costs that could fiscally impact municipal or county governments. The rulemaking has no adverse impact on small business, as all providers impacted by these rules employ more than twenty employees. Effective Date: July 1, 2009 Agency Contact Person: Derrick Grant, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive, 11 SHS Augusta, Maine 04333-0011 Telephone: (207)-287-6427 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ======================================================================== =========== Chapter Number And Title: MaineCare Benefits Manual, Section 46, Psychiatric Hospital Services, Chapter II Concise Summary: These emergency rules establish admission eligibility and continuing eligibility criteria for psychiatric hospitals. These changes will assure the efficient operation of the MaineCare program by ensuring that only individuals who are eligible receive the service. Further, the administrative burden of utilization review will be lessened if the admission and continuing eligibility criteria are clear from the beginning. Effective Date: July 1, 2009 Agency Contact Person: Derrick Grant, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-6427 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ======================================================================== =========== Chapter Number And Title: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities Concise Summary: These emergency rules amend methodology language throughout Section 80 used to properly establish the prospective per diem rates beginning July 1, 2009 for providers. These rules repeal and replace the emergency rules that are currently in place as of June 11, 2009. These changes include revisions to dates and methodology used to trend forward or inflate direct care and routine costs, updates to the percent of the median used in the July 1, 2009 rebasing calculation, and clarifies the direct care add-on and hold harmless principles. In addition, the Department is repealing the emergency rule for Ch. III, Sec. 67, which was adopted on June 11, 2009, and which adopted a modified methodology for the one time supplemental payment to eligible nursing facilities. The Department is including the CMS approved methodology of the one time supplemental payment as part of this emergency rule, for the purpose of simplifying this complex rule. Finally, this rule making includes a new principle that identifies the methodology used to establish rates for remote island facilities. These emergency rules remain in effect up to ninety (90) days. Effective Date: July 1, 2009 Agency Contact Person: Alyssa Morrison, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ======================================================================== ===== Chapter Number And Title: Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 96, Private Duty Nursing and Personal Care Services Concise Summary: The Department adopts emergency rules for Chapters II and III of Section 96, Private Duty Nursing and Personal Care Services. Specifically, this emergency rule includes two new definitions in the rule. In addition, a new level of eligibility, level IX, is added for MaineCare members who require medication administration and assistance with ADLs or IADLs. Two new provider codes are added to Chapter III to permit reimbursement for these services. Effective Date: July 1, 2009 Agency Contact Person: Alyssa Morrison, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ======================================================================== = Agency: Department of Health and Human Services, Office of MaineCare Services Chapter Number And Title: MaineCare Benefits Manual, Chapter III, Section 109, Speech and Hearing Services Concise Summary: These emergency rules establish increased rates of reimbursement for speech and hearing agencies to comply with FY 2010 budget requirements. Effective Date: July 1, 2009 Agency Contact Person: Derrick Grant, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-6427 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 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 . 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 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/20090707/bec394cb/attachment.html From provider at lists.maine.gov Tue Jul 7 16:26:08 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 7 Jul 2009 16:26:08 -0400 Subject: [Provider] Adopted rules: PNMI and Non-categorical adults Message-ID: This message is to give notice that these rules were recently adopted. Adopted rules are final and no changes can be made at this point. Private Non-Medical Institution Services Non-Categorical Adults Agency: Department of Health and Human Services, MaineCare Services Chapter Number And Title: MaineCare Benefits Manual, Chapter III, Section 97, and Appendices B, D, E, and F, Private Non-Medical Institution Services Concise Summary: These rules permanently adopt emergency rules already in place that have recently been approved by the Maine State Legislature in LR 1883(03). The rules eliminate bedhold day reimbursement for PNMI services. Specific changes in these rules include that bedhold day codes are eliminated from Chapter III, including BQL, BRL, MRPL, RHL RHL9, RML RML2, RTSL, and PL. Some language regarding occupancy rates was also eliminated from Appendices B, D, E, and F. The Department also replaced some local codes with HIPAA-compliant standard codes that will not be implemented until further notice when the new claims system is operating. Providers will be given prior notice of the change for these billing codes. Effective Date: July 2, 2009 Agency Contact Person: Patricia Dushuttle, Manager, Division of Policy and Performance Agency Name: Department of Health & Human Services 442 Civic Center Drive 11 State House Station Augusta, ME 04333-0011 Telephone: (207)-287-4459 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) ================================================================== Chapter Number And Title: MaineCare Benefits Manual, Chapter X, Section 2 (Non-Categorical Adults) Back to Top Concise Summary: The final rule repeals MaineCare Benefits Manual, Chapter X, Section 2, Benefits for Childless Adults, because most of the sub-sections duplicate rules in the MaineCare Eligibility Manual, Section 11000, and promulgates a new Chapter X, Section 2, now called Non-Categorical Adults, listing the covered services for this coverage group. In July 2008, the Department repealed sections 58, 100, and 111, and incorporated those services into Section 65 services. The covered services have not changed but the list of covered services has been revised to reflect the changes made in the consolidated MaineCare Benefits Manual, Chapter II, Section 65, Behavioral Health Services rules, adopted as final rules on October 29, 2008. This rule will not have any adverse impact on the administration of small businesses. Effective Date: 6/30/2009 Agency Contact Person: Melanie Miller, Health Planner Division of Policy and Performance Agency Name: Department of Health & Human Services 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-4459 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 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 . 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 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/20090707/8dedd7f9/attachment.html From provider at lists.maine.gov Fri Jul 10 11:44:48 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 10 Jul 2009 11:44:48 -0400 Subject: [Provider] Proposed rules: various Message-ID: This message is to give notice that these rules were recently proposed. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. Community Support Restriction Plans Home Health Services Rule Title Or Subject: 10-144, Ch 101, MaineCare Benefits Manual, Chapters II & III, Section 17, Community Support Services Back to top Concise Summary: These proposed rules specify a new level of service called Community Rehabilitation Services to provide community support to qualifying individuals with an assessed need for that level of service. The rules replace the Global Assessment Functioning (GAF) scale with the Level of Care Utilization System (LOCUS) as a component of eligibility criteria for Community Support Services. The rules specify the services and delivery requirements for ACT clients. The rules provide HIPAA-compliant billing codes for use in the Maine Integrated Health Management Solution (MIMHS) system when it is implemented. The rules also include some formatting and other technical changes to improve clarity. Public Hearing: July 28, 2009, 1:00 -3:00 PM Conference Room 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04333 Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before July 21, 2009. Deadline For Comments: Comments must be received by midnight, Friday, August 7, 2009 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ======================================================================= Rule Title Or Subject: MaineCare Benefits Manual, Chapter IV, Restriction Plans Back to top Concise Summary: The proposed rule restructures the restriction plans from two to four plans to improve the health care of MaineCare members and to integrate Member Lock-In plans with the new MaineCare claims system, Maine Integrated Health Management System (MIHMS). Lock-In type 1 requires a member to be restricted to a designated Primary Care Physician, a Hospital, a Prescriber, a Pharmacy and any other applicable health care professional. Lock-In type 2 restricts the member to one or multiple types of health care providers. Lock-In type 3 restricts the member to one or multiple specific prescriber(s) for their prescriptions. Lock-In type 4 restricts the member from being able to obtain a specific drug category (class). Additionally, the rule is renamed. Public Hearing: July 31, 2009 9-11AM Conference Room # 1A & B Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before July 24, 2009. Deadline For Comments: Comments must be received by midnight, Monday, August 10, 2009. Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ===================================================================== Rule Title Or Subject: Chapter 101 MaineCare Benefits Manual, Chapter II and III, Section 40, Home Health Services Back to top Concise Summary: The Department proposes changes to the above named section of policy. Specifically, in Chapter II, the Department is proposing to change ?40.05-E, Medical Supplies, which will eliminate routine supplies as a separately coverable service. The costs associated with these supplies will be included in the service rates listed in Chapter III. Furthermore, this section also clarifies language for non-routine supplies to state that these supplies are not billable under section 40 and must be billed under section 60. In addition, the Department is simultaneously proposing Chapter III and proposes new HIPAA compliant codes for the reimbursable services under this section. These coding changes are required in order to comply with Federal statute. All changes must be approved by the legislature as these are major substantive rules and are planned to go in effect upon implementation of MIHMS. Public Hearing: August 5, 2009, 1:00 PM Conference Room # 3 Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before July 29, 2009. Deadline For Comments: Comments must be received by midnight August 15, 2009. Agency Contact Person: Alyssa Morrison, Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ====================================================================== The Division of Policy posts all proposed and recently adopted rules 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 . 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 ListServ Subscription 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/20090710/01e3e3a5/attachment.html From provider at lists.maine.gov Fri Jul 10 12:06:00 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 10 Jul 2009 12:06:00 -0400 Subject: [Provider] Adopted rules: various Message-ID: This message is to give notice that these rules were recently adopted. Adopted rules are final and no changes can be made at this point. Community Support Hospital Services Medical Supplies and Durable Medical Equipment Chapter Number And Title: 10-144, CH 101, MaineCare Benefits Manual, Chapters II & III, Section 17, Community Support Services Concise Summary: These emergency rules specify a new level of service called Community Rehabilitation Services to provide community support to qualifying individuals with an assessed need for that level of service. The rules replace the Global Assessment Functioning (GAF) scale with the Level of Care Utilization System (LOCUS) as a component of eligibility criteria for Community Support Services. The rules specify the services and delivery requirements for ACT clients. The rules provide HIPAA-compliant billing codes for use in the Maine Integrated Health Management Solution (MIMHS) system when it is implemented. The rules also include some formatting and other technical changes to improve clarity. Effective Date: 7/1/09 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Division of Policy and Performance Services Address: 442 Civic Center Drive 1 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) Chapter Number And Title: MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services - EMERGENCY RULE Concise Summary: These emergency rules establish admission eligibility and continuing eligibility criteria for hospital psychiatric unit services. These changes will assure the efficient operation of the MaineCare program by ensuring that only individuals who are eligible receive the service. Further, the administrative burden of utilization review will be lessened if the admission and continuing eligibility criteria are clear from the beginning. Effective Date: July 1, 2009 Agency Contact Person: Derrick Grant, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207)-287-6427 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) Chapter Number And Title: Ch. 101, MaineCare Benefits Manual, Chapter II, Section 60, Medical Supplies and Durable Medical Equipment Concise Summary: The adopted rules reflect changes to repeal and replace Section 60 in order to clarify the policy and to achieve legislatively mandated cost savings. Proposed changes include new language under Limitations, additional prior authorization requirements, and new language to clarify that items procured under a contract with the Department must be purchased, billed and reimbursed according to the terms of the contract. This Section has been totally replaced due to extensive formatting changes, including a thorough restructuring of the Appendix. Changes made to the Section 60 proposed rule based on the State budget include: increasing the markup of the acquisition cost of DME to 40% from 30%, and DME providers must deduct any prompt payment discounts when determining the acquisition cost of DME. Several additional changes were made to clarify the Section 60 proposed rule due to comments received and legal review, such as; sleep studies for CPAP and Bi-Pap done within the last three (3) years will be accepted; limits for incontinent supplies for members under 21 were removed; and the time to obtain a written prescription for a Power Mobility Device was changed to 45 days. The adopted rule does not impose an economic burden on municipalities or counties. The adopted rules are not expected to increase reporting, record keeping, or other administrative costs or skills necessary for reporting or recording for small businesses. Effective Date: July 1, 2009 Agency Contact Person: Darrell S. Wood, Health Planner Agency Name: Division of Policy and Performance Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone:(207)-287-6348 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 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 . 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 ListServ Subscription 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/20090710/3d60e09d/attachment.html From provider at lists.maine.gov Tue Jul 14 08:52:00 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 14 Jul 2009 08:52:00 -0400 Subject: [Provider] Conference call re - NDC codes for hospital outpatient services Message-ID: Attention: All Hospital Providers On Thursday, July 16th from 3:00 - 4:00, MaineCare will host a roundtable discussion on National Drug Codes for hospital outpatient services. Topics will include * Expected changes in 2010; * The state legislature's goal to collect more drug rebates; and, * How NDC codes will be handled in the new system, MIHMS. The conference number is 1-800-394-6604, and participant code is 934057. There is no need to RSVP to join the call. We apologize for the short notice. Contact Cheryl Rood with questions. 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 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/20090714/32e2134a/attachment.html From provider at lists.maine.gov Tue Jul 14 13:12:52 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 14 Jul 2009 13:12:52 -0400 Subject: [Provider] Proposed rule: Free-Standing Dialysis Services Message-ID: This message is to give notice that these rules were recently proposed. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. Agency: Department of Health and Human Services, Office of MaineCare Services Rule Title Or Subject: MaineCare Benefits Manual, Chapters II & III, Section 7, Free-Standing Dialysis Services Concise Summary: The proposed rule is a new section of the MaineCare Benefits Manual. Currently, providers of dialysis services are billing MaineCare under Section 90, Physician Services. The Physician Services rule does not contain any policy pertaining to dialysis services. This new rule is a stand-alone policy for dialysis providers with its own definitions; covered services, including renal dialysis, prescribed drugs, and training for home dialysis; eligibility requirements; reimbursement; limitations; and billing instructions. This rule is not expected to have any adverse impact on small business. Public Hearing: Date: July 22, 2009, 1PM Location: Conference Room #1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04333-0011 Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before Friday, July 17, 2009. Deadline For Comments: Comments must be received by midnight August 3, 2009. Agency Contact Person: Nicole Rooney Agency Name: Office of MaineCare Services 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 or Hard of Hearing) The Division of Policy posts all proposed and recently adopted rules 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 . 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 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/20090714/3aa206c5/attachment.html From provider at lists.maine.gov Thu Jul 16 09:13:48 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 16 Jul 2009 09:13:48 -0400 Subject: [Provider] Rescheduled hearing for Free Standing Dialysis Services proposed rule Message-ID: The public hearing for MaineCare Benefits Manual, Chapters II & III, Section 7 Free-Standing Dialysis Services has been rescheduled to August 12, 2009 at 1PM. Its location has also been changed: the hearing will be held at Conference Room #4 Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04333-0011 Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before Friday, August 7, 2009. Since the hearing has been rescheduled, the deadline for comments has also changed: Comments must be received by midnight August 24, 2009. The Division of Policy posts all proposed and recently adopted rules 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 . 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 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/20090716/ff3876b5/attachment.html From provider at lists.maine.gov Thu Jul 16 13:23:16 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 16 Jul 2009 13:23:16 -0400 Subject: [Provider] PNMI Providers Appendix D and E Message-ID: ATTENTION: PNMI providers of Appendix D and E An emergency PNMI rule will be published soon. The new rule is expected to become effective on August 1, 2009. Appendix D, Children's PNMI The emergency rule attaches the level of funding to a child rather than designating facilities to a specific level of service. The Intensive Temporary Residential Treatment (ITRT) team will continue to refer children to programs that they believe can best serve the child closest to his home. By July 31, 2009, Office of Child and Family Services (OCFS) staff will meet with providers to review projected levels of need by home and by district. In the meantime, the Department will continue to work with providers to serve children within available resources. Thank you for your patience as we work to improve delivery of residential services. We look forward to talking with you. 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 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/20090716/8fcb64dc/attachment.html From provider at lists.maine.gov Thu Jul 16 14:58:39 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 16 Jul 2009 14:58:39 -0400 Subject: [Provider] DME Dealers: incontinent supply limits Message-ID: In talking with DME dealers and Invacare Supply Group, the Department has realized that the initial limits placed on incontinent supplies are not practical. The initial limits would have required dealers to split packaging, possibly creating unsanitary conditions/products. Accordingly, this letter clarifies the policy for incontinent supplies. This clarification will be effective immediately and will be formally adopted in a subsequent policy revision. Starting July 1, 2009, the following quantity limits for incontinent supplies apply to all members age 21 and older: 1. Disposable briefs are limited to 8 units per day for adults; 2. Disposable pull-ons are limited to 4 per day for adults; 3. Disposable personal pads, liners, shields, guards and undergarments are limited to 1 case (of 150) per 36 day period for adults; 4. Large sized disposable underpads are limited to 1 case (of 150) per 36 day period for adults. 5. Disposable non-sterile gloves are limited to 5 boxes (at 100 per box) or 500 gloves per member per 36 day period for adults. 6. Disposable wipes are covered if the member is receiving incontinence products paid for by MaineCare. Disposable wipes are limited to 8 boxes (at 50 per box) or 400 disposable wipes per member per 36 day period for adults. Providers may ship up to a 72-day supply. Members may refuse to accept more than a 36-day supply. For questions regarding this policy you may contact Jennifer Cook at (207)287-2705 or by email Jennifer.Cook at Maine.gov. 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 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/20090716/e4be445d/attachment.html From provider at lists.maine.gov Tue Jul 21 16:17:12 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 21 Jul 2009 16:17:12 -0400 Subject: [Provider] Incontinent Supply Formulary, Rates for August 1, 2009 Message-ID: MaineCare's new two-year contract with Invacare for incontinent supplies starts August 1, 2009. Procedure codes and pricing are listed below. The pricing will apply to any supplies provided to MaineCare members on or after August 1. The incontinent supply formulary and incontinent supply FAQs are available on MaineCare's website. If you have questions about Invacare services or products, feel free to contact Peter Kaplan by e-mail at pkaplan at invacare.com or by phone at 508-634-5133. If you have questions about the Invacare contract, please contact Jennifer Cook at 287-2705 or Jennifer.Cook at maine.gov . Thank you for serving MaineCare members. Procedure Description Code Invacare Price AQC * 40% Unit of Measure Wipes T4335 $1.69 $2.36 Box of 50* Non-sterile gloves per 100 A4927 $3.57 $5.00 Per box of 100 Adult size brief/diaper sm T4521 $0.26 $0.36 Per piece (unit)** Adult size brief/diaper med T4522 $0.30 $0.42 Per piece (unit) Adult size brief/diaper lg T4523 $0.39 $0.55 Per piece (unit) Adult size brief/diaper xl T4524 $0.47 $0.66 Per piece (unit) Adult size pull-on sm T4525 $0.45 $0.63 Per piece (unit) Adult size pull-on med T4526 $0.39 $0.55 Per piece (unit) Adult size pull-on lg T4527 $0.45 $0.63 Per piece (unit) Adult size pull-on xl T4528 $0.56 $0.78 Per piece (unit) Ped size brief/diaper sm/med T4529 $0.35 $0.49 Per piece (unit) Ped size brief/diaper lg T4530 $0.46 $0.64 Per piece (unit) Ped size pull-on sm/med T4531 $0.46 $0.64 Per piece (unit) Ped size pull-on lg T4532 $0.57 $0.80 Per piece (unit) Youth Size Brief/Diaper T4533 $0.28 $0.39 Per piece (unit) Youth size pull-on T4534 $0.606 $0.85 Per piece (unit) Disposable liner/ shield/ guard/ pad/ undergarment for incontinence T4535 $0.32 $0.45 Per piece (unit) Large disposable underpad T4541 $0.17 $0.24 Per piece (unit) Small disposable under pad T4542 $0.11 $0.15 Per piece (unit) Protective Underwear Reusable T4536 $7.05 $9.87 Per piece (unit) Reusable Underpads T4537 $5.25 $7.35 Per piece (unit) $6.65 $9.31 Per piece (unit) Bariatric brief/ diaper T4543 $0.63 $0.88 Per piece (unit) * Limit 8 boxes per month. ** Example: a box of 16 units would be billed $0.36 X 16 = $5.76 _______________________________________________________________________ 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 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/20090721/3f25f781/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: incontinent_formulary_080109.xls Type: application/vnd.ms-excel Size: 56832 bytes Desc: incontinent_formulary_080109.xls Url : http://mailman.informe.org/pipermail/provider/attachments/20090721/3f25f781/incontinent_formulary_080109.xls -------------- next part -------------- A non-text attachment was scrubbed... Name: incontinent_supp_FAQs_080109.doc Type: application/msword Size: 57856 bytes Desc: incontinent_supp_FAQs_080109.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20090721/3f25f781/incontinent_supp_FAQs_080109.doc From provider at lists.maine.gov Tue Jul 28 08:40:28 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 28 Jul 2009 08:40:28 -0400 Subject: [Provider] Proposed rules: Adults with Physical Disabilities, Hospital Services, Nursing Facilities Message-ID: This is notice of recently proposed rules. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. Section 22 Home and Community Benefits for Adults with Physical Disabilities Section 45 Hospital Services Section 67 Nursing Facilities Rule Title Or Subject: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 22, Home and Community Benefits for Adults with Physical Disabilities Concise Summary: The Department proposes to adjust the rates for personal care attendant services under this section. Specifically, the proposal increases the rate from $2.57 to $2.61 per fifteen minutes. This is being proposed because the rate that was adopted in March 2009 did not adjust for the total amount of state funds allocated for the program. In order to claim full Federal match for this program, this rate needs to be adjusted an additional four cents. In addition, this rate is now consistent with the personal care attendant rates reimbursed under Section 12 of the MaineCare Benefits Manual. See http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents. Public Hearing: August 17th at 1 PM Location: Conference Room # 4 Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before August 10, 2009. Deadline For Comments: Comments must be received by midnight August 27, 2009 Agency Contact Person: Alyssa Morrison, Health Planner Agency name: Office Of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ======================================================================== ========= Rule Title Or Subject: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services Concise Summary: The Department is proposing to permanently adopt emergency rules currently in place that reduce hospital reimbursement. As mandated by the Legislature, in P.L. 2009, ch. 213, Part CC, effective July 1, 2009 the Department reduced hospital reimbursement. For acute care non-critical access hospitals, inpatient discharge rates (except for those from psychiatric units) were reduced 6.7% and reimbursement for outpatient services was decreased to 83.8% of costs. For critical access hospitals and hospitals reclassified to a wage area outside Maine, reimbursement for inpatient and outpatient services was reduced to 109% of costs. For all acute care hospitals, including critical access, hospital based physician reimbursement was decreased from 100% to 93.3% of allowable costs for inpatient non-emergency physicians, to 93.4% of costs for inpatient emergency physicians and to 83.8% of costs for outpatient non-emergency physicians. In addition, these emergency rules eliminated the COLA adjustment for SFY's 2010 and 2011 for non critical access acute care hospitals for inpatient discharge rate and for psychiatric unit discharge rates. The Department capped the PIP payment so that the total payment to all hospitals is not less than 80%. All of the above mentioned changes are contingent upon approval from CMS. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents or visit your local DHHS agency where this rule proposal can be accessed for you. Public Hearing: August 19, 2009, 1 p.m. Location: Conference Room # 3 Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04330 Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before August 10, 2009. Deadline For Comments: Comments must be received by midnight, August 31, 2009. Agency Contact Person: Derrick Grant, Comprehensive Health Planner Agency Name: Office of MaineCare Services Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-6427 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ======================================================================== ============ Rule Title Or Subject: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities Concise Summary: The Department is proposing to permanently adopt emergency rules that became effective July 1, 2009. Specific proposed changes include: revisions of dates and methodology used to trend forward or inflate direct care and routine costs, updating the percent of the median used in the July 1, 2009 rebasing calculation, and clarifying the direct care add-on and hold harmless principles. In addition, the Department is proposing the one-time payment methodology, which is already approved by CMS. Furthermore, this proposal includes a new principle that identifies the methodology used to establish rates for remote island facilities. Other minor and technical changes are considered in this rule making. See http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents. Public hearing: August 26, 2009, 1 PM Location: Conference Room # 3 Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before August 16, 2009. Deadline For Comments: Comments must be received by midnight, September 6, 2009. Agency Contact Person: Alyssa Morrison, Health Planner Agency Name: Office of MaineCare Services Address: 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9368 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing ------------------------------------------------------------------------ -------------------------------------------------- The Division of Policy posts all proposed and recently adopted rules 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 . 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 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/20090728/68f45406/attachment.html From provider at lists.maine.gov Tue Jul 28 13:34:26 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 28 Jul 2009 13:34:26 -0400 Subject: [Provider] PB and PC modifiers Message-ID: ATTENTION: MaineCare Providers using "PB" and "PC" modifiers Some providers are continuing to submit claims with modifiers "PB" and "PC". The modifiers "PB" and "PC" were discontinued by CMS more than five years ago. They were re-instated on July 1, 2009 with the following descriptions: PB- Surgical or other invasive procedure on wrong patient PC- Wrong surgery or other invasive procedure on patient If these modifiers are inadvertently submitted on or after July 1, 2009, and claims are paid, this would be considered an overpayment. Under Chapter I, Section 1.12-2 A, the provider must then report the overpayments. If overpayments are not reported, then the Department will, as a result of a review, contact the provider and request repayment. If you have any questions, please contact Customer Service at 1-800-321-5557 option #8. 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 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/20090728/53baf16b/attachment.html From provider at lists.maine.gov Tue Jul 28 15:38:07 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 28 Jul 2009 15:38:07 -0400 Subject: [Provider] Provider Services closed on Friday, August 31 Message-ID: On Friday, July 31, 2009 Provider Services Office at 1-800-321-5557 Option 9 will be closed for the day so that staff may attend training. You can get eligibility and claims data on the Interactive Voice Response (IVR) system at 1-800-321-5557 Option 2 and /or 1-800-452-4694. You can also check claims status on the OMS website at: https://www.maine.gov/dhhs/oms/providerfiles/prov_portal_tools.html MaineCare Billing & Information staff will be available on Friday at 1-800-321-5557 Option 8. The Provider Services office will resume normal business hours at 8:00 am on Monday, August 3, 2009. 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 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/20090728/4f155cd5/attachment.html From provider at lists.maine.gov Tue Jul 28 15:42:08 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 28 Jul 2009 15:42:08 -0400 Subject: [Provider] Incontinent supply billing code Message-ID: MaineCare has updated its procedure code for incontinent wipes. Starting August 1, 2009, please use the code S5199, personal care product to bill incontinent wipes. The rate for the code is $0.047 each, or $2.36 for a box of 50. If you have questions, feel free to contact MaineCare Customer Service at 1-800-321-5557 Option #8. 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 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/20090728/9ac6f72d/attachment.html From provider at lists.maine.gov Tue Jul 28 16:20:39 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 28 Jul 2009 16:20:39 -0400 Subject: [Provider] Correction: Provider Services closed Friday July 31 Message-ID: An earlier message referred to the wrong month. The correct date that MaineCare Provider Services will be closed is Friday, July 31st. The MaineCare Billing and Information line will remain open at 1-800-321-5557 Option #8. 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 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/20090728/574b761c/attachment.html From provider at lists.maine.gov Thu Jul 30 16:29:23 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 30 Jul 2009 16:29:23 -0400 Subject: [Provider] Emergency rule: Targeted Case Management Message-ID: This message is to give notice that emergency rules for Section 13 Targeted Case Management Services, will be filed on Friday, July 31st and adopted effective Saturday, August 1st, 2009. Implementation will be delayed until September 1st to give providers the opportunity to register with APS as necessary and appropriate. Emergency rules will be effective for 90 days at which time the Department will adopt the permanent rule. A copy of the rule is attached for your information. If you have any questions, please feel free to contact the Office Director in your program area. Concise Summary: The Department is repealing and replacing Targeted Case Management rules in this Emergency rulemaking. Services in the former rule will no longer be available upon implementation of these rules. Target groups have been consolidated and redefined. Several target groups are being deleted, including Pregnant and Postpartum women, Adults with Diabetes and Asthma and Members who are receiving Healthy Futures Services. The Department is adding language detailing eligibility criteria for Children and Adults to include Case Management Services for Children with Developmental Disabilities and Behavioral Health Disorders as well as Case Management Services for Adults with Developmental Disabilities, Behavioral Health Disorders, Substance Abuse Disorders, HIV, Long Term Care Needs and Members Experiencing Homelessness. Children's targeted case management services require prior authorization, . This rule also reduces funding for children's targeted case management by limiting services to two (2) months for children with scores between fifty (50) and seventy (70) on the Child and Adolescent Functional Assessment Scale. The assessment tool score may not be the sole criterion for determining medical necessity, needs and/or eligibility. This rulemaking contains changes to the TCM service and delivery required by federal Medicaid regulation. 42 C.F.R. ? ? 440.169 and 441.18. For example, this rule clarifies that MaineCare will not cover multiple case management services; and sets forth the eligibility process, and the requirement of transitioning to one comprehensive case manager for children and adult members. Chapter III establishes new billing procedure codes based on HIPAA compliant HCPCS coding. Chapter III also implements a change in reimbursement to some Providers/Case Management Agencies through the requirement of billing in fifteen (15) minute increments. Record-keeping requirements for TCM providers have been added to the rule. On June 1, 2009, the Department mailed a notice to TCM recipients notifying them of changes to the TCM service. On June 31, 2009, the Department published a Notice of Change in Medicaid Reimbursement Methodology to notify TCM providers of rate changes. The Department anticipates achieving a cost savings in the General Fund of $ 4,138,665 per State fiscal year 2010/2011. The Department expects an annual decrease in annual aggregate (state and federal) expenditures of $11,744,223.00 per State fiscal year 2010/2011. Other than providers of these specific services, This rule is not expected to fiscally impact or create new recording burdens for other small businesses and is not expected to yield new costs for municipal or county governments. Effective Date: August 1, 2009 Agency Contact Information: Melanie Miller Health Planner Division of Policy and Performance Department of Health & Human Services 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone(207)-287-4459 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 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 . 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 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/20090730/65b715a1/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Section 13 Emergency FINAL.doc Type: application/msword Size: 182272 bytes Desc: Section 13 Emergency FINAL.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20090730/65b715a1/Section13EmergencyFINAL.doc -------------- next part -------------- A non-text attachment was scrubbed... Name: Sec 13 Chap III Emergency FINAL .doc Type: application/msword Size: 40448 bytes Desc: Sec 13 Chap III Emergency FINAL .doc Url : http://mailman.informe.org/pipermail/provider/attachments/20090730/65b715a1/Sec13ChapIIIEmergencyFINAL.doc From provider at lists.maine.gov Fri Jul 31 09:44:54 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Jul 2009 09:44:54 -0400 Subject: [Provider] DHHS Commissioner message Message-ID: Dear Providers: As some of you may know, we are in the process of shifting some of our management functions among our existing Executive Leadership Team. This change is the culmination of months of strategic planning that included the Commissioner's team, Office Directors, and their key managers. It is our on-going attempt to look at our organizational structure and incorporate legislative input, our practice, and good management policy and practice. These changes represent more movement toward aligning program functions in the most efficient way. I have retained the three Deputies, but changed the programs they oversee somewhat. Muriel Littlefield will continue to be the Deputy Commissioner of Integrated Services and she will continue to focus on the program areas; the Office of Integrated Access and Support has been moved to Operations and Benefits Administration under Geoff Green. He will also focus on claims processing aspects of Maine Care operations and oversee the fiscal agent contract as well as continue to oversee licensing and regulatory services. Russ Begin will continue to oversee all finance functions including but not limited to MaineCare finance, audit, purchased services, and rate-setting for all programs. Four people currently employed by DHHS will join the Commissioner's Executive Management Team. Dora Mills, MD who directs Maine CDC and serves as the State Health Officer will help us focus on the State Health Plan, Healthy Maine 2010 and our Pan Flu Plan. Ron Welch will facilitate the work we have targeted to further integrate services to adults and Jim Beougher will continue work to address those areas specific to children. Tony Marple will continue to oversee the Medicaid Plan and will focus on several initiatives; hospital reimbursement, physician and medical home development and electronic health information exchange. Together we will manage these efforts to achieve a more streamlined and efficient, effective DHHS. I look forward to working with you in partnership in the coming year, as we face some more difficult challenges. Brenda M. Harvey Commissioner 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 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/20090731/94d86695/attachment.html From provider at lists.maine.gov Fri Jul 31 15:58:45 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Jul 2009 15:58:45 -0400 Subject: [Provider] 15-day limit on first-time prescriptions for certain drugs Message-ID: MaineCare has begun instituting measures to ensure cost effectiveness through the use of Drug Benefit Management, Drug-Drug editing to ensure education and patient safety, recent PPI limitations and Intensive Benefit Management with controlled substances. For a number of years in Maine, research from the Maine Benzodiazepine Study Group, The University of Maine Center on Aging, and in part funded by the only Federal Grant in the US on unused drug return mail back programming has suggested that adherence to medication and other variables may lead to large amounts of unused and discarded medication. Closer evaluation of side effects and efficacy may lead to better patient outcome and better safety for patients with closer evaluation of initial response. With that, MaineCare will institute new 15 day limits on initial prescriptions for various medication that have been identified with high side effect profiles, high discontinuation rates, or frequent dose adjustments to ensure cost effectiveness without "wasting" or "discarding" of used medications. Effective 8/6/09 MaineCare will begin limiting initial prescriptions on the following medications, Suboxone, Subutex, Chantix and Nicotine replacement products to 15 day supplies. Initial prescriptions for preferred products over the initial 15 day supply will require prior authorization. Subsequent refills of these products will be allowed at the usual MaineCare allowable days supply. For further questions please contact Goold Health Systems at 1-888-4450497. 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 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/20090731/8beca1a2/attachment.html