[Provider] Proposed rules: various
Provider Notification
provider at lists.maine.gov
Fri Jul 10 11:44:48 EDT 2009
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
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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)
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Rule Title Or Subject: MaineCare Benefits Manual, Chapter IV, Restriction Plans
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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)
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Rule Title Or Subject: Chapter 101 MaineCare Benefits Manual, Chapter II and III, Section 40, Home Health Services
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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)
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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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