[Provider] Adopted rules: PNMI and Non-categorical adults

[Provider Notification]

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  In July 2008, the Department repealed sections 58, 100, and 111,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
<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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time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

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This is a one-way communication.  Do not reply to this e-mail.  Your
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