[Provider] Proposed Rules: 10 MaineCare services
Provider Notification
provider at lists.maine.gov
Tue Jul 7 13:05:58 EDT 2009
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
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapter III, Section 21, Home and Community Benefits for Members with Mental Retardation or Autistic Disorder.
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapters II and III, Section 23, Developmental and Behavioral Evaluation Clinic Services
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapter III, Section 29, Community Benefits for Members with Mental Retardation and Autistic Disorder.
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapters II & III, Section 62, Genetic Testing and Clinical Genetic Services
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapters II and III, Section 96, Private Duty Nursing and Personal Care Services
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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)
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Rule Title or Subject:
MaineCare Benefits Manual, Chapters II and III, Section 150, STD Screening Clinic Services
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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 <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> .
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