[Provider] Emergency rule: Targeted Case Management

[Provider Notification]

This message is to give notice that emergency rules for Section 13 Targeted Case Management Services, will be filed on Friday, July 31st and adopted effective Saturday, August 1st, 2009.  Implementation will be delayed until September 1st to give providers the opportunity to register with APS as necessary and appropriate.  Emergency rules will be effective for 90 days at which time the Department will adopt the permanent rule.  

 

A copy of the rule is attached for your information.  If you have any questions, please feel free to contact the Office Director in your program area. 

 

Concise Summary: The Department is repealing and replacing Targeted Case Management rules in this Emergency rulemaking. Services in the former rule will no longer be available upon implementation of these rules. Target groups have been consolidated and redefined.  Several target groups are being deleted, including Pregnant and Postpartum women, Adults with Diabetes and Asthma and Members who are receiving Healthy Futures Services.  The Department is adding language detailing eligibility criteria for Children and Adults to include Case Management Services for Children with Developmental Disabilities and Behavioral Health Disorders as well as Case Management Services for Adults with Developmental Disabilities, Behavioral Health Disorders, Substance Abuse Disorders, HIV, Long Term Care Needs and Members Experiencing Homelessness. Children's targeted case management services  require prior authorization, . This rule also reduces funding for children's targeted case management by limiting services to two (2) months for children with scores between fifty (50) and seventy (70) on the Child and Adolescent Functional Assessment Scale. The assessment tool score may not be the sole criterion for determining medical necessity, needs and/or eligibility. 

 

This rulemaking contains changes to the TCM service and delivery required by federal Medicaid regulation.  42 C.F.R. § § 440.169 and 441.18.  For example, this rule clarifies that MaineCare will not cover multiple case management services; and sets forth the eligibility process, and the requirement of transitioning to one comprehensive case manager for children and adult members. Chapter III establishes new billing procedure codes based on HIPAA compliant HCPCS coding. Chapter III also implements a change in reimbursement to some Providers/Case Management Agencies through the requirement of billing in fifteen (15) minute increments.  Record-keeping requirements for TCM providers have been added to the rule. 

 

On June 1, 2009, the Department mailed a notice to TCM recipients notifying them of changes to the TCM service.  On June 31, 2009, the Department published a Notice of Change in Medicaid Reimbursement Methodology to notify TCM providers of rate changes.  

 

The Department anticipates achieving a cost savings in the General Fund of $ 4,138,665 per State fiscal year 2010/2011. The Department expects an annual decrease in annual aggregate (state and federal) expenditures of $11,744,223.00 per State fiscal year 2010/2011.   

 

Other than providers of these specific services, This rule is not expected to fiscally impact or create new recording burdens for other small businesses and is not expected to yield new costs for municipal or county governments.

 

Effective Date: August 1, 2009 

 

Agency Contact Information: 

 

Melanie Miller Health Planner

Division of Policy and Performance

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/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> .  

 

Is your mailing address up to date with MaineCare?  Please keep MaineCare up to date so your Remittance Statements and checks arrive on time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

If you would rather not get these e-mails, visit MaineCare's List Serve Subscription <http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml>  page to unsubscribe.

 

This is a one-way communication.  Do not reply to this e-mail.  Your e-mail will not receive response.  If you have questions, please call 1-800-321-5557.  

 

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