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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>An emergency rule, MaineCare Benefits Manual, Chapter III Section 45
Hospital Services, was adopted February 1, 2009 and was repealed on February
21, 2009. A new emergency rule replaced it effective February 21, 2009. This
is notice of the new emergency rule. <o:p></o:p></span></font></p>
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12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The U.S. Centers for Medicare and Medicaid Services’ (CMS)
approval is required before this rule can be permanently adopted. <o:p></o:p></span></font></p>
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12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>AGENCY:</span></font></b><font
size=2><span style='font-size:11.0pt'> Department of Health and Human Services,
Office of MaineCare Services<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>CHAPTER NUMBER AND TITLE: </span></font></b><font
size=2><span style='font-size:11.0pt'> MaineCare Benefits Manual, Chapter III,
Section 45, Hospital Service<b><i><span style='font-weight:bold;font-style:
italic'><o:p></o:p></span></i></b></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>ADOPTED RULE NUMBER: <o:p></o:p></span></font></b></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>CONCISE SUMMARY: </span></font></b><font
size=2><span style='font-size:11.0pt'> The Fiscal Year 2009 Emergency
Supplemental Budget, deappropriated funds to reduce MaineCare reimbursement for
hospital-based physician services to provide for a rate as close to 70% of the
Medicare reimbursement rate as the Department determines can be funded with the
resources used for physician reimbursement, as adjusted by the Supplemental
Budget, which reduced the reimbursement by $1,947,490 state dollars, effective
February 1, 2009. P.L. 2009, ch. 1. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>On February 1, 2009, the Department adopted emergency rules which
reduced reimbursement for both hospital-based inpatient and outpatient
physicians. Since February 1, 2009, the Department has determined that the
February 1<sup>st</sup> emergency rule must be repealed because upon further
review, the Department determined that it would be less administratively
burdensome on hospitals to limit the impact to non-emergency hospital-based
outpatient physician services only, rather than to all hospital-based
physicians, within the required savings of $1,947,490 state dollars.
Accordingly, the Department is repealing the February 1, 2009 emergency rules
and will be adopting, simultaneously, these emergency rules, which are being
adopted effective February 21, 2009. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>Hence, in accordance with P.L. 2009, ch. 1, the Department is adopting
these emergency regulations, with an effective date of February 21, 2009, which
will reduce reimbursement for hospital-based physician services as follows:
non-emergency hospital-based outpatient physician rates at acute care
non-critical access hospitals, acute care critical access hospitals and
hospitals reclassified to a wage area outside Maine, will be reduced to 46.21%
of non-emergency hospital-based outpatient physician costs. The rate of 46.21%
is the closest to 70% of the Medicare reimbursement rate that the Department
could fund with the resources used for physician reimbursement, as adjusted by
the Supplemental Budget, which reduced the reimbursement by $1,947,490 of
state dollars. Prospective Interim Payments (PIPs) will be lowered in an
amount corresponding to the anticipated non-emergency hospital-based outpatient
physician payment reductions. <o:p></o:p></span></font></p>
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11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;text-transform:uppercase;font-weight:bold'>S</span></font></b><b><font
size=2><span style='font-size:11.0pt;font-weight:bold'>ee</span></font></b><font
size=2><span style='font-size:11.0pt'> <b><span style='font-weight:bold'><a
href="http://www.maine.gov/bms/rules/provider_rules_policies.htm">http://www.maine.gov/bms/rules/provider_rules_policies.htm</a>
for rules and related rulemaking documents.<o:p></o:p></span></b></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>EFFECTIVE DATE: </span></font></b><font
size=2><span style='font-size:11.0pt'>February 21, 2009 <b><span
style='font-weight:bold'><o:p></o:p></span></b></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>AGENCY CONTACT PERSON:</span></font></b><font
size=2><span style='font-size:11.0pt'> Bob Kohl, Health Planner<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> <b><span style='font-weight:bold'>AGENCY NAME:</span></b> Division
of Policy and Performance<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> <b><span style='font-weight:bold'>ADDRESS:</span></b> 442
Civic Center Drive<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> 11 State
House Station<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> <st1:place
w:st="on"><st1:City w:st="on">Augusta</st1:City>, <st1:State w:st="on">Maine</st1:State>
<st1:PostalCode w:st="on">04333-0011</st1:PostalCode></st1:place><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'> <b><span style='font-weight:bold'>TELEPHONE:</span></b>
(207)-287-6124 FAX: (207) 287-9369<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:2.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of
Hearing) <o:p></o:p></span></font></p>
<pre><font size=2 face="Courier New"><span style='font-size:10.0pt'><o:p> </o:p></span></font></pre><pre><font
size=2 face="Courier New"><span style='font-size:10.0pt'>_______________________________________________________________________<o:p></o:p></span></font></pre><pre><i><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-style:italic'>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. <o:p></o:p></span></font></i></pre><pre><i><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-style:italic'><o:p> </o:p></span></font></i></pre><pre><i><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-style:italic'>If you would rather not get these e-mails, visit MaineCare’s <a
href="http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml">List Serve Subscription Page</a> to unsubscribe.<o:p></o:p></span></font></i></pre><pre><i><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-style:italic'><o:p> </o:p></span></font></i></pre><pre><i><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-style:italic'>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 call1-800-321-5557.<o:p></o:p></span></font></i></pre>
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12.0pt'><o:p> </o:p></span></font></p>
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