From provider at lists.maine.gov Thu Sep 3 12:47:55 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 3 Sep 2009 12:47:55 -0400 Subject: [Provider] Proposed rules: Dental, Private Non-Medical Institutions, Message-ID: This is notice of proposed rules. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapters II and III, Section 25, Dental Services CONCISE SUMMARY: The Department of Health and Human Services is proposing changes to the MaineCare Benefits Manual, Chapters II and III, Section 25, Dental Services. The Department proposes amending the language in sub-section 25.03-2 (G) for Tobacco Cessation counseling to be consistent with the language in Chapter III, Section 90, Physician's Services. The Department is also proposing the addition of language to sub-section 25.04-1 For Adult Dental Care Requirements. The language will clarify criteria for imminent tooth loss, pursuant to 22 M.R.S.A ?3174-F. Furthermore, the Department is proposing the removal of Appendix III-Supplemental Payment to General Dentists. Instead the Department is increasing the reimbursement for selected dental codes in Chapter III of this Policy. PUBLIC HEARING: Date: September 28, 2009 1PM Location: Conference Room # 1A/1B Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME DEADLINE FOR COMMENTS: Comments must be received by midnight October 8, 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: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) ======================================================================= RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter II, Private Non-Medical Institution Services CONCISE SUMMARY: These proposed rules will permanently adopt emergency rules already in effect for prior authorization of behavioral health PNMI services. The rules also propose additional prior authorization criteria for other PNMI services, and the Department is adding language detailing medical eligibility criteria. These changes are necessary to assure that PNMI services are medically necessary and that more cost effective community based services are used to the fullest extent possible. In this Section, the Department is also defining models of children's PNMI services for which standard rates are being set in a separate rulemaking pertaining to reimbursement of PNMI services in Chapter III, Section 97. The Maine State Legislature has directed the Department to achieve $6.8 million savings per State fiscal year in this rulemaking for children's services. Another $ 1.7 million of savings is expected through the scattered site housing changes. PUBLIC HEARING: Date: September 22, 2009 10:00 am Location: Conference Room Department of Health and Human Services, MaineCare Services 442 Civic Center Drive, Augusta, Maine DEADLINE FOR COMMENTS: Comments must be received by midnight October 4, 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: 1-800-423-4331 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/20090903/f0bdef6d/attachment.html From provider at lists.maine.gov Thu Sep 3 12:53:12 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 3 Sep 2009 12:53:12 -0400 Subject: [Provider] Emergency rule: Targeted Case Management Message-ID: This is notice of an adopted emergency rule. Adopted rules are final and no changes can be made at this point. CHAPTER NUMBER AND TITLE: EMERGENCY RULE: MaineCare Benefits Manual, Chapters II and III, Section 13, Allowances for Targeted Case Management Services CONCISE SUMMARY: The Department has determined that the immediate adoption of these rules is necessary to comply with legislative requirements for budgeted savings in accordance with P.L. 2009, ch. 213, Part CC..Additionally, the Maine Legislature authorized the Department to do emergency rulemaking in connection with budget initiatives, without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety or general welfare. P.L. 2009, ch. 213, Part RRRR. The Department adopted emergency targeted case management rules with an effective date of August 1, 2009. After that date, the Department realized that the emergency rules excluded coverage for individuals receiving protective services, and that these individuals had a critical need of the TCM services. Accordingly, the Department determined that it needed to adopt this emergency rule to get services to this critical group of individuals. This emergency rule contains the following changes to the August 1, 2009 emergency rule: (1) Includes coverage to individuals who receive protective services; (2) changes billing for some TCM services from 15 minute increments to monthly billing; and (3) changes eligibility for homeless individuals so that these individuals are not required to have resided in a homeless shelter either currently or in the past 90 days. 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. Pursuant to 5 M.R.S.A. ? 8054, the Department has determined that immediate adoption of this provision is necessary to avoid an immediate threat to public health, safety or general welfare because of the economic crisis facing the State of Maine. The U.S. economy is in a deep recession. Maine faces a deficit of approximately $780 million for the 2010-2011 biennium. The Department determined that changes to Targeted Case Management Services were necessary, along with the legislatively mandated budgeted savings, to assure that the financial crisis did not deepen. These rules will remain in effect for 90 days while the Department proposes the rules through the regular Administrative Procedures Act (APA) process to permanently adopt the rules. A public hearing will be held as part of that process. 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: 8/31/09 AGENCY CONTACT PERSON: Steven R. Davis, Director of Policy and Performance AGENCY NAME: Department of Health and Human Services, MaineCare Services, Division of Policy and Performance Services ADDRESS: 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-9371 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/20090903/144f57c7/attachment.html From provider at lists.maine.gov Thu Sep 3 16:24:30 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 3 Sep 2009 16:24:30 -0400 Subject: [Provider] 15-day limit will apply to more drugs Message-ID: To avoid wasting medications, MaineCare began limiting first-time prescriptions for certain drugs. Starting August 6, 2009, members getting Suboxone, Subutex, Chantix, and nicotine replacement products for the first time could get only 15 days worth. We are now expanding the list of drugs that will be subject to the limit. Starting September 11, 2009, the following medications will be limited to 15-day supplies on first-time fills: Bladder antispasmodics: Bethanechol, Detrol, Flavoxate, Oxybutynin, Sanctura, Urispas, Vesicare, Detrol LA, Ditropan XL, Enablex, Oxytrol, Toviaz, and Narcotics: Opana, Oxycodone, Avinza, Duragesic, Fentanyl, Kadian, Methadone, Morphine sulfate, Opana ER, Oramorph, and Oxycontin. Providers can get prior authorization to dispense more than 15 days' supply of preferred products. Subsequent refills of these products will be allowed, under the usual MaineCare rules. For questions, please contact Goold Health Systems at 1-888-420-9711. 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/20090903/a5a1e003/attachment.html From provider at lists.maine.gov Thu Sep 10 09:33:03 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 10 Sep 2009 09:33:03 -0400 Subject: [Provider] Provider Re-enrollment Message-ID: ATTENTION: All MaineCare Providers MaineCare Re-enrollment for MIHMS is well underway for Cycle 1 Providers Cycle 1 Providers: Please follow this link https://mainecare.maine.gov to the Health PAS provider re-enrollment portal to complete the re-enrollment application before September 16, 2009. It is important to the MIHMS implementation process and projected staff workload that providers re-enroll in a timely manner according to their assigned cycle. To begin the process, please click on the Provider Enrollment link in the middle of the left pane menu. Please check this site to verify your assigned re-enrollment cycle http://www.maine.gov/dhhs/oms/pdfs_doc/fiscal_agent/prov_list.xls . If you believe you are not assigned to the correct cycle, please contact us at MaineCare2010.dhhs at maine.gov. Re-enrollments have been staggered to allow for processing of all current MaineCare Providers in an efficient and timely manner. Following this established schedule will allow for payments to be made in the first MIHMS financial cycle. Providers who have not re-enrolled will experience delays in claims processing. Please do not delay - get your application in now! The schedule for re-enrollment is: Cycle 1: August 19 through September 16 Cycle 2: September 17 through October 14 Cycle 3: October 15 through November 13 Cycle 2 Providers: Re-enrollment begins September 17, 2009! Please note: Providers should not attempt to re-enroll prior to their assigned dates. The re-enrollment application is being updated to reflect policy revisions and attempting to re-enroll early will result in an inability to complete the re-enrollment application. Questions regarding re-enrollment can be sent 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/20090910/b0084e22/attachment.html From provider at lists.maine.gov Thu Sep 10 14:48:57 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 10 Sep 2009 14:48:57 -0400 Subject: [Provider] Schools offering seasonal flu and H1N1 vaccines Message-ID: Schools that are MaineCare providers will receive by mail information about billing MaineCare for flu vaccine administration. The information is also posted on MaineCare's website . The mailing omitted instructions on how to return the enrollment form. You can return the enrollment form by * U.S. Mail: Office of MaineCare Services, State House Station #11, Augusta, ME 04333 * E-mail: Provider Enrollment Unit or * Fax: 207-287-8450 If you have questions, feel free to contact MaineCare's Billing & Information line 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/20090910/31eefd2f/attachment.html From provider at lists.maine.gov Thu Sep 17 13:34:03 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 17 Sep 2009 13:34:03 -0400 Subject: [Provider] Make sure your software vendor gets MaineCare info In-Reply-To: References: Message-ID: Soon, we will be contacting software vendors that serve MaineCare providers and we need your help. Could you please check our list of software vendors to confirm that your vendor(s) are included? If yours is not on the list or if you have questions, please send an e-mail to MaineCare2010.dhhs at maine.gov by Friday, September 25, 2009 with the following: * Company Name * Contact Person * E-Mail address * Mailing Address * Telephone * Website - optional Thank you for your help! 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/20090917/5943a085/attachment.html From provider at lists.maine.gov Thu Sep 17 14:40:28 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 17 Sep 2009 14:40:28 -0400 Subject: [Provider] MaineCare Providers who have more than one provider type Message-ID: ATTENTION: Providers with Multiple Provider Types enroll in only one Cycle Providers with multiple provider types should re-enroll in the latest cycle in which they have a provider type. Providers with more than one provider type which are in Cycle 1 and Cycle 2 should re-enroll in Cycle 2. Providers with more than one provider type which are in either Cycle 1, 2, or 3 should re-enroll in Cycle 3. For example, providers with a Mental Health Clinic (third cycle) and a PNMI (second cycle) will enroll in the third cycle. This provider would not enroll each provider type separately as listed. It is very important that you enroll in the correct cycles. If you enroll in the wrong cycle, this could result in your application being withdrawn and your re-enrollment delayed. Please check this site to verify your assigned re-enrollment cycle http://www.maine.gov/dhhs/oms/pdfs_doc/fiscal_agent/prov_list.xls . If you believe you are not assigned to the correct cycle, please contact us at 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/20090917/89e43b7e/attachment.html From provider at lists.maine.gov Tue Sep 22 09:52:26 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 22 Sep 2009 09:52:26 -0400 Subject: [Provider] Rate correction, office visit code Message-ID: The MaineCare rate for procedure code 99244, office consultation has been corrected to $121.31. Claims that were paid incorrectly have been adjusted by the computer system. Providers will see an adjustment payment on their September 30 or October 7 Remittance Statement. If you have questions, feel free to contact MaineCare's Billing and Information line 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/20090922/b5a3c156/attachment.html From provider at lists.maine.gov Wed Sep 23 10:28:35 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 23 Sep 2009 10:28:35 -0400 Subject: [Provider] Provider Re-enrollment Update Message-ID: ATTENTION: All MaineCare Providers MaineCare Re-enrollment for MIHMS is well underway for Cycle 1 Providers Cycle 1 Providers: The official deadline for re-enrollment is September 16, 2009. However it is not too late for you to re-enroll. Please visit the Health PAS provider re-enrollment portal to complete your re-enrollment application as soon as possible. To begin the process, please click on the In-State Provider Enrollment link in the middle of the left pane menu. Please check this site to verify your assigned re-enrollment cycle http://www.maine.gov/dhhs/oms/pdfs_doc/fiscal_agent/prov_list.xls . If you believe you are not assigned to the correct cycle, please contact us at MaineCare2010.dhhs at maine.gov. In order to get paid in the first financial cycle in the new claims system, providers need to re-enroll on time. Please do not delay - get your application in now! The schedule for re-enrollment is: Cycle 1: August 19 through September 16 Cycle 2: September 17 through October 14 Cycle 3: October 15 through November 13 Cycle 2 Providers: Re-enrollment is now open to you! When you enroll: Cycle 1 and 2 providers should click on the "In State Provider Enrollment" (please do not click on the "register") link located in the left menu pane to begin the re-enrollment process. Do you know your NPI Type? Providers should visit the NPI Registry and search their NPI number(s) to determine how they enumerated. Knowing your NPI type is important when you re-enroll! You need to verify if you are a Type 1 - individual or a Type 2 - Organization. Please note: Providers should not attempt to re-enroll prior to their assigned dates. The re-enrollment application is being updated for MaineCare policy changes. If you re-enroll before your assigned cycle begins, you may not be able to finish the application. Questions about re-enrollment can be sent 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/20090923/efd31b9e/attachment.html