[Provider] FW: Adopted rules: Sections 21 (HCB for Members with MR or Autistic Disorder), 45 (Hospital services), and 97 (PNMI)

[Provider Notification]

Type of Rule:             Adopted (These rules are final and no changes can be made at this point)

 

 Section 21 Home and Community Benefits for Members with Mental Retardation or Autistic Disorder

 Section 45, Hospital Services

Section 97, and Appendices B, D, E, and F, Private Non-Medical Institution Services

 


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:  This rule permanently adopts major substantive rules approved by the Maine State Legislature and currently in effect by emergency rule.  

 

EFFECTIVE DATE:                          June 8, 2009

 

AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner

      TELEPHONE:                    (207)-287-9365 FAX: (207) 287-9369

             TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing)

______________________________________________________________________________

 

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CHAPTER NUMBER AND TITLE:  MaineCare Benefits Manual, Chapters II and III, Section 45, Hospital Services


 

CONCISE SUMMARY:  This adopted rule adjusts hospital reimbursement methodology.  Chapter III, Section 45 clarifies and revises reporting requirements and defines the MaineCare Supplemental Data Form, and clarifies that cross-over payments are made to the extent required by CMS.  Chapter III also increases the supplemental pool to be distributed among non-critical access hospitals from approximately $36 to $45 million and counts 50% of the psychiatric discharges when distributing the pool; increases the pool for the critical access hospital from $2 to 3.5 million; increases the PIP cap to approximately 81%; creates a separate section for Hospitals Reclassified to a Wage Area Outside Maine by the Medicare Geographic Classification Review Board and limits reimbursement under that section to hospitals reclassified prior to the effective date of the rule; revises sections 45.03, 45.04, 45.05 and 45.06 to separate the calculation of the PIP from the calculation of the Department's obligation at settlement; establishes base discharge rates for acute care non-critical access hospitals (Franklin Memorial hospital services rate was changed due to a revision made to the base year report); and removes outdated material.  Several provisions have a retroactive effective date of 10/1/08.  Pursuant to 22 M.R.S.A. §42(8), the Department is authorized to adopt rules with retroactive application when, as here, it is necessary to maximize available revenue sources, and there is no adverse financial impact on any MaineCare provider or member.

 

These rules permanently adopt emergency rules, effective February 21, 2009, that reduce hospital-based physician reimbursement to 46.21% of costs, which is the closest to 70% of the Medicare fee schedule that the Department could fund with the resources used for physician reimbursement, as adjusted by the Supplemental Budget, which reduced reimbursement by $1,947,490 of state dollars.  A percentage of costs is being used to calculate 70% of the Medicare fee schedule absent claims-based data.  Prospective Interim Payments (PIP) will be lowered in an amount corresponding to the anticipated hospital-based physician payment reimbursement, which are paid separately and not paid as part of PIP.  Permanent adoption of this methodology change will be contingent upon approval by the U.S. Center for Medicare and Medicaid Services (CMS).

 

Two proposed changes were withdrawn as a result of comments and legislative action.  The provision for hospitals to report professional services on a CMS 1500 form separate from facility fees was withdrawn due to a moratorium enacted by Congress.  Also, the reimbursement of non-emergency room hospital-based physicians at 70% of the Medicare fee schedule was withdrawn due to contrary pending legislation in the 1st session of the 124th Legislature.  Two links were updated in Chapter II, Section 45.11 and Section 45.12.

 

This rulemaking does not adversely impact counties or municipalities, and it does not adversely impact small businesses of twenty (20) or fewer employees because the service affected by the rate reduction is not provided by small businesses.

 

EFFECTIVE DATE:                          May 23, 2009

 

AGENCY CONTACT PERSON:       Derrick Grant, Health Planner

      TELEPHONE:                             (207)-287-6124  FAX: (207) 287-9369

             TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing)


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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:                          June 15, 2009

 

AGENCY CONTACT PERSON:       Patricia Dushuttle, Manager, 

                                                            287-9362

 

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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