From provider at lists.maine.gov Tue Nov 3 10:01:48 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 3 Nov 2009 10:01:48 -0500 Subject: [Provider] Proposed rules: Day Habilitation, DME, PNMI, and Restriction Plans Message-ID: This is notice of four recently proposed rules. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. Section 24, Day Habilitation Services, and Section 28 Rehabilitation and Community Support Services for Children with Cognitive Impairments and Functional Limitations Section 60, Medical Supplies and Durable Medical Equipment Section 97 Private Non-Medical Institution (PNMI) Services, and Appendix D and E Chapter IV Restriction Plans RULE TITLE OR SUBJECT: 10-144 Chapter 101, MaineCare Benefits Manual, Chapters II & III, Section 24, Day Habilitation Services, and Chapters II & III, Section 28 Rehabilitation and Community Support Services for Children with Cognitive Impairments and Functional Limitations. PROPOSED RULE NUMBER: CONCISE SUMMARY: The Department is proposing a new MaineCare section, Section 28, which will provide current Section 24 services, as well as additional services, to an expanded children's eligibility group. The Department is repealing Section 24 because it is deleting this service for adults. The Department anticipates that most adults who now receive Section 24 services will be provided this service under some institutional providers. The Department will provide advance written notice to members to inform them of this reduction and change in service. See http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents. THIS RULE WILL __ WILL NOT ___ HAVE A FISCAL IMPACT ON MUNICIPALITIES. STATUTORY AUTHORITY: 22 M.R.S.A., ? 42, ? 3173. PUBLIC HEARING: Date: November 17, 2009 10:30 AM to 12:30 PM Location: Conference Room # 1A 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 November 2, 2009. DEADLINE FOR COMMENTS: Comments must be received by midnight, November 27, 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: 1-800-606-0215 or 207-287-1828 (Deaf or Hard of Hearing) RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter II, Section 60, Medical Supplies and Durable Medical Equipment PROPOSED RULE NUMBER: CONCISE SUMMARY: The Department is proposing changes to MaineCare Benefits Manual, Chapter II, Section 60, Medical Supplies and Durable Medical Equipment to achieve required savings in the budget law, in accordance with PL 2009, ch. 213. The Department is proposing changes to its reimbursement methodology so that it will reimburse for DME/Medical Supplies as follows: (1) For DME/medical supplies that are not "miscellaneous DME/medical supplies" or made available through an exclusive contract with the Department, providers will be reimbursed at the lower of: the Medicare rate, the provider's Usual and Customary Charge or a MaineCare fee schedule published on the Department's website. (2) For DME/medical supplies, which contains the phrase "miscellaneous," "accessories," "not otherwise specified" or "not otherwise classified" in its description, MaineCare will reimburse at either the Manufacturers' Suggested Retail Price (MSRP) minus twenty percent (20%) or in cases where there is no listed MSRP, providers will be paid their Usual and Customary Charges minus thirty percent (30%). (3) Where the Department has entered into a contract with a supplier, the Department will reimburse based on the price contained in the contract. In addition, the Department (1) will no longer provide coverage for non-sterile wipes for all MaineCare members; (2) is placing limits on pressure mattress pads, commodes, walkers, pneumonic compressor devices, apenea monitors, etc., (3) is defining criteria for reclining wheelchairs; (4) is clarifying standards for phototherapy for the treatment of seasonal affective disorder; and (5) is reducing the amount of allowable incontinence supplies. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents. THIS RULE WILL __ WILL NOT _X__ HAVE A FISCAL IMPACT ON MUNICIPALITIES. STATUTORY AUTHORITY: 22 M.R.S.A., ? 42, ? 3173, PUBLIC HEARING: Date: Monday, November 23, 2009, 1PM Location: 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 November 19, 2009. DEADLINE FOR COMMENTS: Comments must be received by midnight December 3, 2009 AGENCY CONTACT PERSON: Nicole Rooney, Comprehensive Health Planner AGENCY NAME: Office of MaineCare Services ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: 207-287-4460 FAX: (207) 287-9369 TTY: 1-800-606-0215 or 207-287-1828 (Deaf or Hard of Hearing) RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter III, Section 97 Private Non-Medical Institution (PNMI) Services, and Appendix D and E. PROPOSED RULE NUMBER: CONCISE SUMMARY: In this major substantive rulemaking, the Department is proposing to provisionally adopt the August 1, 2009 Emergency Substantive PNMI, Ch. III Rule, currently in effect as well as propose other additional clarifications. The Department proposes to amend Appendix D (Child Care PNMI Facilities) by deleting the cost settlement requirement. Instead, the Department is proposing to adopt a standardized capitated rate for five (5) levels of child services based on a child's diagnosis and level of acuity. These rates were established by analyzing data from claims and time studies and unbundling service components to establish an Upper Payment Limit. The Department has added new billing codes for children's services. The capitated rate includes reimbursement for all PNMI services required by a child for his/her category of level of care including all staffing required both by Maine licensing guidelines, and as identified in the child's individual service plan, The Legislature mandated the 5 levels of child services in its budget initiative enacted into law (P.L. 2009, ch. 213, Part CC). The Department proposes to amend Appendix E (Community Residences for Persons with Mental Illness) by deleting "scattered site" PNMI services. The Department anticipates that those services will still be provided to members in their apartments, but instead will be reimbursed through Community Support Services under Section 17 of the MaineCare Benefits Manual. Other proposed changes in Chapter III update billing codes for the Department's new claims system for all other PNMI services, and clarify in Chapter III where language pertaining to auditing cost reports no longer applies to Appendix D PNMI services. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents. THIS RULE WILL __ WILL NOT _X__ HAVE A FISCAL IMPACT ON MUNICIPALITIES. STATUTORY AUTHORITY: 22 M.R.S.A., ? 42, ? 3173, PL 2009, ch. 213, Part A PUBLIC HEARING: Date: November 17, 2009 1:00 pm Location: Conference Room 1A Department of Health and Human Services, MaineCare Services 442 Civic Center Drive, Augusta, Maine Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before November 10, 2009. DEADLINE FOR COMMENTS: Comments must be received by midnight November 29, 2009 AGENCY CONTACT PERSON: Patricia Dushuttle, Manager, Division of Policy and Performance AGENCY NAME: Office of MaineCare Services ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: 207-287-9362 FAX: (207) 287-9369 TTY: 1-800-606-0215 or 207-287-1828 (Deaf or Hard of Hearing) AGENCY: Department of Health and Human Services, Office of MaineCare Services RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter IV, Restriction Plans PROPOSED RULE NUMBER: CONCISE SUMMARY: The rule was proposed in July 2009, and due to compelling comments, the rule has been clarified. 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 the core providers of a Primary Care Physician, a Hospital, 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. See http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents. THIS RULE WILL __ WILL NOT X HAVE A FISCAL IMPACT ON MUNICIPALITIES. STATUTORY AUTHORITY: 22 M.R.S.A., ? 42, ? 3173 PUBLIC HEARING: Date: November 16, 2009 1-3 PM Location: 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 November 2, 2009. DEADLINE FOR COMMENTS: Comments must be received by midnight, November 26, 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) The Division of Policy posts all proposed and recently adopted rules 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 . 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091103/2e2e8ae3/attachment.html From provider at lists.maine.gov Tue Nov 10 08:53:25 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 10 Nov 2009 08:53:25 -0500 Subject: [Provider] Reprocessing Overpaid Claims Message-ID: Reprocessing March 2005 Claims to Recoup Overpayments MaineCare Services reviewed claims that were overpaid on March 12, 2005 and March 19, 2005. During that time, the claims system (MeCMS) paid certain claims at 100% of charges rather than MaineCare's maximum allowed amount. MaineCare will reprocess claims for providers whose overpayments total $2,500.00 or less. You need do nothing. The adjustment will appear on your Remittance Advice (RA) statement within 6 weeks. If MaineCare overpaid you more than $2,500.00, you will receive a letter from Program Integrity. Questions? Contact MaineCare Billing & Information at 1-800-321-5557 Option 8. 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091110/0424183c/attachment.html From provider at lists.maine.gov Tue Nov 10 14:10:39 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 10 Nov 2009 14:10:39 -0500 Subject: [Provider] Companion Guides now online Message-ID: MIHMS Companion Guides (Electronic claims filing guides) are available online! MIHMS Companion Guides are now posted on the Unisys Provider Portal. (Maine Integrated Health Management Solution, "MIHMS") Six guides appear on the site: * 270 Eligibility Benefit Inquiry * 276 Claim Status Request * 278 Health Services Review * 837 Dental * 837 Institutional * 837 Professional The purpose of these Companion Guides is to clarify, supplement and further define specific data content requirements to be used in conjunction with the HIPAA Implementation Guides (version 004010-A1) created for the electronic transactions standards mandated by the HIPAA regulations. Another listserv will go out at a later date with HIPAA EDI claims file testing and approval time frames. Send your questions to MaineCare2010.DHHS at maine.gov 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091110/24c4ae35/attachment.html From provider at lists.maine.gov Thu Nov 12 08:19:02 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 12 Nov 2009 08:19:02 -0500 Subject: [Provider] Enrolling rendering providers Message-ID: ATTENTION: All MaineCare Providers that are not In-State Hospitals (In-state hospitals have received a separate notice) MaineCare is aware that some providers are not able to re-enroll certain rendering providers (RP). In these instances, the following error message is received: This is due to the fact that a RP employed by another pay-to provider cannot be in process for re-enrollment at the same time. This design is intentional to ensure that there are no data conflicts with pending re-enrollments in the system. Please do not delay the submission of your re-enrollment application as indicated in the error message above. A. In order to assist you in completing and submitting your electronic applications for re-enrollment promptly, we ask that you follow these instructions when this error occurs: 1. Complete your application for re-enrollment with as many rendering providers as you are able to re-enroll. 2. Keep a list on the attached spreadsheet of all rendering providers for whom you receive the error message above. 3. Complete the remaining application screens and submit your electronic application. 4. Then, complete the additional data required in the spreadsheet for each rendering provider you could not re-enroll. 5. E-mail the fully completed rendering provider spreadsheet to mainecareenroll at unisys.com. 6. Once your initial application for re-enrollment is approved, a provider enrollment specialist will enter your additional rendering providers for you from the completed spreadsheet. You may be contacted and asked to return to the portal to sign off on additional attestations, if needed. 7. You will receive notification as your rendering providers are approved in the system. 8. Please contact Provider Enrollment at (800) 321-5557, option 6 for assistance if you have any questions. B. A similar situation may be encountered by independent practitioners who are also providing services for a group or organization. That individual may receive the same error when attempting to re-enroll. If this should happen, please contact Provider Relations at (800) 321-5557, option 8 for assistance. Thank you! 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091112/fee7c7b7/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: not available Type: image/jpeg Size: 13019 bytes Desc: image001.jpg Url : http://mailman.informe.org/pipermail/provider/attachments/20091112/fee7c7b7/attachment.jpe From provider at lists.maine.gov Thu Nov 12 08:20:37 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 12 Nov 2009 08:20:37 -0500 Subject: [Provider] Spreadsheet for enrolling rendering providers Message-ID: A list serve message sent this morning omitted the attachment. The spreadsheet mentioned is attached. 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091112/055cebc0/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: RenderingProviderSpreadsheet20091110.xls Type: application/vnd.ms-excel Size: 82944 bytes Desc: RenderingProviderSpreadsheet20091110.xls Url : http://mailman.informe.org/pipermail/provider/attachments/20091112/055cebc0/RenderingProviderSpreadsheet20091110.xls From provider at lists.maine.gov Thu Nov 12 09:16:22 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 12 Nov 2009 09:16:22 -0500 Subject: [Provider] Chronic Narcotic Use Guidelines Message-ID: Due to increasing concerns regarding the appropriate, safe use of long-term narcotics, the Pharmacy Unit of the Office of MaineCare Services will expand the scope of its chronic narcotic prescription monitoring efforts starting January 1, 2010. The specific goal is to promote the widespread adoption of key elements of the existing standards of care (most notably the joint Rule 11 of the Boards of Licensure in Medicine and Osteopathy) as they pertain to "new" chronic narcotic patients. This effort will require a prior authorization (PA) for any member who has had 90 days of narcotics in the past 100 days (and no chronic, sustained narcotic prescriptions in the previous nine months; i.e.new chronic starters). A PA will not be required for hospice patients or for those members being actively treated for a life threatening illness such as AIDS or cancer. It is expected that 100 to 130 MaineCare members per month would meet the criteria requiring such a PA. Providers will be given thirty days to complete the Prior Authorization. Pharmacies will be granted overrides to continue dispensing narcotics during this time period for all affected patients. The PA will concentrate on determining how thoroughly the following principles of pain management have been addressed: * Confirming an appropriate indication for chronic narcotics * Reviewing non-pharmacologic and non-opioid drug treatments considered and/or tried * Verification that a narcotic/controlled substance contract exists * Reviewing the intended monitoring plan (such as whether Urine Screens and Random Pill Counts may be appropriate). * Verification that Prescription Monitoring Program reports are used routinely and not misinterpreted It is anticipated that only a handful (minimum of 1 to maximum of 5) of Chronic Narcotic Use Prior Authorizations will be required of each provider. Some patients will require a follow-up PA 3 to 12 months later to see how well actual monitoring results and contract violations are handled. Exemptions will be granted quickly once it is clear that appropriate selection and reevaluation/monitoring of chronic narcotic patients is occurring. Providers may wish to take advantage of a consultation program for chronic pain jointly sponsored and supported by the Maine Medical Association and the Maine Board of Licensure in Medicine. This program provides free, professional consultations. To schedule a visit to your practice contact Noel Genova directly at noelpac at aol.com or 207-671-9076, or Kellie Miller at kmiller at mainemed..com or 622-3372 ext. 229. We will soon publish a list of Narcotics that will be included in the monitoring program. Please bring your questions, concerns or comments to the Drug Utilization Review Committee on November 10. The meeting begins at 6pm with the open session closing at 7:30 and is located at the Office of MaineCare Services, 442 Civic Center Dr. Augusta. Or you can email Jennifer.Palow at maine.gov pharmacy Unit Manager, Office of MaineCare Services. Thank you for serving MaineCare members. 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091112/ffb9812b/attachment.html From provider at lists.maine.gov Thu Nov 12 11:41:21 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 12 Nov 2009 11:41:21 -0500 Subject: [Provider] Discontinued HCPC/CPT codes Message-ID: The Center for Medicare and Medicaid Services (CMS) has released updates for 2010 HCPC/CPT codes. The discontinued HCPC/CPT codes cannot be used after date of service 12/31/2009. Although the CPT codes are not posted, the CMS site does list the HCPCS code additions/deletions and changes (Click on: 2010 Alpha-Numeric HCPCS File 11/05/2009) If you have billing questions, please contact MaineCare Customer Service at 1-800-321-5557 Option 8. 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091112/93d2b400/attachment.html From provider at lists.maine.gov Thu Nov 12 15:12:25 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 12 Nov 2009 15:12:25 -0500 Subject: [Provider] Clarification: March 2005 claims adjustments Message-ID: MaineCare will be processing certain claims overpaid in March 2005, as noted in a previous list serve message. The claims that were reviewed came from only three provider types: * Physicians/assistants/nursing * Laboratory services * Medical imaging Providers who were overpaid $2,500 or less will see an adjustment on their Remittance Advice Statement in the next six weeks. Providers who were overpaid more than $2,500 will get a letter from Program Integrity. Questions? Contact MaineCare Billing & Information at 1-800-321-5557 Option 8. 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091112/3bde4018/attachment.html From provider at lists.maine.gov Wed Nov 18 12:01:19 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 18 Nov 2009 12:01:19 -0500 Subject: [Provider] Provider Enrollment in the new claims system Message-ID: To: All MaineCare Providers It's not too late to re-enroll! If you have not yet re-enrolled in the Maine Integrated Health Management Solution (MIHMS), it is not too late! Re-enroll now! You must re-enroll in MIHMS, in order to request prior authorizations and submit claims. Providers not re-enrolled by December 23, 2009 risk delays in claims processing and prior authorization approvals when MIHMS goes live. Do not delay!! Please visit the MIHMS Health PAS provider portal to complete your re-enrollment application today! Click on the appropriate provider enrollment link in the middle of the left pane of the portal. If you need help with or have questions about your re-enrollment, please call 1-800-321-5557, option 6, or e-mail MaineCare2010.DHHS at maine.gov. Staff is available to assist you from 8:00 am to 5:00 pm. One-on-one appointments may also be scheduled to help you with your on-line re-enrollment application. 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091118/f23bff25/attachment.html From provider at lists.maine.gov Fri Nov 20 12:24:34 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Nov 2009 12:24:34 -0500 Subject: [Provider] Electronic Data Interchange (EDI) presentation on-line Message-ID: The presentation for the Electronic Data Interchange (EDI) Kick-Off Meeting held on November 12th at the Augusta Civic Center is now available on-line. If you have any questions regarding the presentation or EDI please e-mail mainecaresupport at unisys.com . 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091120/ec0571bd/attachment.html From provider at lists.maine.gov Fri Nov 20 12:51:28 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Nov 2009 12:51:28 -0500 Subject: [Provider] Emergency rules: Pharmacy Services Message-ID: This message is to give notice that emergency rules for MaineCare Benefits Manual Chapter II, Section 80, Pharmacy Services on November 18, 2009. Adopted rules are final and no changes can be made at this point. Emergency rules remain in effect for 90 days. A regular rulemaking, including a public comment period, will begin within the next 90 days. AGENCY: Department of Health and Human Services, Office of MaineCare Services CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services CONCISE SUMMARY: The Department has determined that the immediate adoption of these rules is necessary to avoid an immediate threat to public health, safety, or general welfare. The threat to public health is due to the expected escalation of H1N1 (swine flu) this fall. Accordingly, MaineCare is immediately adding reimbursement for administration of seasonal flu shots (H1N1) and other allowed vaccines under 32 MRSA ? 13831 for licensed Maine pharmacists retroactive to October 1, 2009. Furthermore, retroactive to November 1, 2009, MaineCare pharmacies who compound the drug Tamiflu for MaineCare children and othe MaineCare members where there is a medical need and where the pharmacy is unable to provide Tamiflu Suspension will receive a $10.00 compounding fee. This is so that MaineCare children are not denied access to a medically necessary antiviral during this flu season. This emergency rulemaking will allow the Department to immediately work with pharmacists so that they can be reimbursed for the administration of these vaccines. These rules will remain in effect for 90 days while the Department permanently adopts these changes in a proposed rulemaking. A public hearing will be held as part of that separate rulemaking. EFFECTIVE DATE: November 18, 2009 AGENCY CONTACT: Nicole Rooney, Health Planner AGENCY NAME: Division of Policy and Performance ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-4460 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 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 . 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 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20091120/d26ff325/attachment.html