[Provider] Adopted rules: various

Fri Jul 10 12:06:00 EDT 2009

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
<http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html>  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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