[Provider] Proposed Rulemaking for MaineCare Benefits Manual Chapter I, Section I

[Provider Notification]

The following rulemaking(s) is now in proposed status.

 

RULE TITLE OR SUBJECT:  

MaineCare Benefits Manual, Chapter I, Section 1, General Administrative
Policies and Procedures

 

CONCISE SUMMARY:  

The Department has proposed changes that include the addition of an
Appendix that references the False Claims Act that results in changes to
the provider/supplier documentation and compliance requirements.  The
Department is also proposing a change in the language that allows
providers seven (7) days from the termination notice to request an
informal hearing on emergency terminations.  This rulemaking includes
the deletion of language that allowed providers to continue to receive
payments during a judicial review; and a change in language to allow a
provider sixty (60) days to request an informal review upon receipt of
an audit report, examination report or other audit determination, and
any other determinations that seek to impose repayment, recovery or
recoupment obligations or fines from providers.  

 

This rulemaking adds language that addresses reassessment of a member's
medical eligibility, as well as a coding change and clarifying language
for interpreter services.  Additionally, this rulemaking deletes
obsolete language regarding the Physician (and other Prescribers)
Directed Drug Initiative (PDDI).

 

The Department is proposing the addition of new language for a
definition section of this policy.  The terminology defined in this
section is:  Authorized Agent, Emergency Medical Conditions, Emergency
Medical Conditions for Undocumented Non-Citizens and Medical Necessity.
The Department is also proposing Behavioral Health Managed Care language
for the purposes of evaluating utilization management and clinical
appropriateness of services.  All providers must submit notification of
the initiation of behavioral health services prior to the start of
services for all members.  The Department proposes numerous other
clarifying, structural, administrative and grammatical changes within
this rulemaking.

 

Rulemaking documents can be found at:

http://www.maine.gov/bms/rules/provider_rules_policies.htm 

 

PUBLIC HEARING: 

Monday, July 30, 2007 at 1:00 p.m. 

Department of Health and Human Services

Office of MaineCare Services/Conference Room 1B

442 Civic Center Drive

Augusta, ME 

 

DEADLINE FOR COMMENTS:      

Comments must be received by 11:59 p.m. on August 9, 2007

 

AGENCY CONTACT PERSON:      

Alyssa Morrison, Comprehensive Health Planner

 

 

This is notice of a rule that has recently been proposed.  The text of
the rule and other information will be on the MaineCare website shortly.
The link to that website is:

http://www.maine.gov/bms/rules/provider_proposed_mcare.shtml

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

 

 

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