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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>This message is to give notice that rules have been adopted for </span></font><span
class=Heading3Char><b><font face="Times New Roman"><span style='font-family:
"Times New Roman"'>MaineCare Benefits Manual, 10-144, Chapters II of
Section 90- Physician Services, Section 55-Laboratory Services, Section
75-Vision Services, Section 95-Podiatry Services, Section 101-Medical Imaging
and Ch III of Section 90 Physician’s Services</span></font></b></span><b><span
style='font-weight:bold'>. </span></b>Adopted rules are final and no
changes can be made at this point.<o:p></o:p></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=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>CONCISE SUMMARY:</span></font></b>
This letter gives notice of a final rule: MaineCare Benefits Manual
10-144, Chapters II of Section 90- Physician Services and Section
55-Laboratory Services, Section 75-Vision Services, Section 95-Podiatry
Services, Section 101-Medical Imaging and Ch III of Section 90
Physician’s Services. The Department adopts the increase to the MaineCare
reimbursement rate for non-hospital based physician services from 53% to 56.94%
as of July 1, 2008. Furthermore, the Department is proposing to remove some
prior authorization requirements for services including but not limited to
hyperbaric oxygen therapy, cochlear implants, circumcision, septoplasty, and
skin tag removal. <o:p></o:p></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><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Finally the Department is adopting changes to Chapter II Section
55-Laboratory Services, Section 75-Vision Services, Section 95-Podiatry
Services, Section 101-Medical Imaging. The Department has amended the language
under the “reimbursement” sections to these areas of policy to
clarify that the increase mentioned above does not apply to these
services. MaineCare will reimburse the lowest of 53% of 2005 Medicare
rates, the provider’s usual and customary or the allowed amount of the
Medicare Part B carrier for these services. Providers can visit the Office of
MaineCare’s website for a list of MaineCare covered services and rates.
This rule change clarifies what the current rate is; the rate is not being
decreased.<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><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The Department anticipates no impact to small business; however
physicians may need to resubmit claims in order to get the higher
reimbursement. <o:p></o:p></span></font></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>EFFECTIVE DATE:</span></font></b>
March 29, 2009 <b><span style='font-weight:bold'><o:p></o:p></span></b></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>AGENCY CONTACT PERSON:
</span></font></b>Nicole Rooney, Health Planner<o:p></o:p></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>AGENCY NAME:</span></font></b>
Division of Policy <o:p></o:p></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>ADDRESS:</span></font></b>
442 Civic Center Drive<o:p></o:p></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>
11 State House Station<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>
<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><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>TELEPHONE:</span></font></b>
(207)-287-4460 FAX: (207) 287-9369<o:p></o:p></p>
<p class=MsoNormal><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>
<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><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The Division of Policy posts <a
href="http://www.maine.gov/bms/rules/provider_rules_policies.htm">all proposed
and recently adopted rules</a> 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 <a
href="http://www.maine.gov/sos/cec/rules/10/ch101.htm">Secretary of
State’s website</a>. <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>
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<p class=MsoNormal style='border:none;padding:0in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><o:p> </o:p></span></font></p>
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<p class=MsoNormal style='text-autospace:none'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;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></p>
<p class=MsoNormal style='text-autospace:none'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'><o:p> </o:p></span></font></i></p>
<p class=MsoNormal style='text-autospace:none'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'>If you would
rather not get these e-mails, visit <a
href="http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml">MaineCare's
List Serve Subscription</a> page to unsubscribe.<o:p></o:p></span></font></i></p>
<p class=MsoNormal style='text-autospace:none'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'> <o:p></o:p></span></font></i></p>
<p class=MsoNormal><i><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial;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 call 1-800-321-5557.</span></font></i><font size=2
face=Arial><span style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></p>
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