[Provider] Emergency rules: various sections
Provider Notification
provider at lists.maine.gov
Tue Jul 7 16:23:14 EDT 2009
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
<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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