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<div class=Section1>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>Type of
Rule: <u>Adopted
</u></span></font></b>(These rules are final and no changes can be made at this
point)<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'><a href="#_CHAPTER_NUMBER_AND_1"> Section 21 <font size=2><span
style='font-size:11.0pt'>Home and Community Benefits for Members with Mental
Retardation or Autistic Disorder</span></font></a><span class=MsoHyperlink><u><font
color=blue><o:p></o:p></font></u></span></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><a href="#_CHAPTER_NUMBER_AND_"> Section 45, Hospital Services</a><span
class=MsoHyperlink><u><font color=blue><o:p></o:p></font></u></span></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><a href="#_CHAPTER_NUMBER_AND">Section 97, and Appendices B, D, E, and
F, Private Non-Medical Institution Services</a></span></font><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>
<h3><a name="_CHAPTER_NUMBER_AND_1"></a><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-family:"Times New Roman"'>CHAPTER NUMBER AND
TITLE: MaineCare Benefits Manual, Chapter III, Section 21, Home and
Community Benefits for Members with Mental Retardation or Autistic Disorder.<span
class=heading3char0><b><font face="Times New Roman"><span style='font-family:
"Times New Roman"'> <o:p></o:p></span></font></b></span></span></font></b></h3>
<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=MsoBodyText2><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>CONCISE SUMMARY: </span></font></b> This
rule permanently adopts major substantive rules approved by the Maine State
Legislature and currently in effect by emergency rule. <o:p></o:p></p>
<p class=MsoNormal style='text-align:justify'><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'>EFFECTIVE DATE:</span></font></b><font
size=2><span style='font-size:11.0pt'>
June 8, 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'>Ginger Roberts-Scott, Comprehensive
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'>TELEPHONE:</span></b>
(207)-287-9365 FAX: (207) 287-9369<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.5in'><font size=2 face="Times New Roman"><span
style='font-size:11.0pt'>
TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing)<o:p></o:p></span></font></p>
<p class=MsoNormal><b><u><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>______________________________________________________________________________</span></font></u></b><font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>===============================================================================<o:p></o:p></span></font></p>
<h3><a name="_CHAPTER_NUMBER_AND_"></a><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-family:"Times New Roman"'>CHAPTER NUMBER AND
TITLE: MaineCare Benefits Manual, Chapters II and III, Section 45,
Hospital Services<o:p></o:p></span></font></b></h3>
<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=MsoBodyText2><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-weight:bold'>CONCISE SUMMARY: </span></font></b> This
adopted rule adjusts hospital reimbursement methodology. Chapter III,
Section 45 clarifies and revises reporting requirements and defines the
MaineCare Supplemental Data Form, and clarifies that cross-over payments are
made to the extent required by CMS. Chapter III also increases the
supplemental pool to be distributed among non-critical access hospitals from
approximately $36 to $45 million and counts 50% of the psychiatric discharges
when distributing the pool; increases the pool for the critical access hospital
from $2 to 3.5 million; increases the PIP cap to approximately 81%; creates a
separate section for Hospitals Reclassified to a Wage Area Outside Maine by the
Medicare Geographic Classification Review Board and limits reimbursement under
that section to hospitals reclassified prior to the effective date of the rule;
revises sections 45.03, 45.04, 45.05 and 45.06 to separate the calculation of
the PIP from the calculation of the Department’s obligation at
settlement; establishes base discharge rates for acute care non-critical access
hospitals (Franklin Memorial hospital services rate was changed due to a
revision made to the base year report); and removes outdated material.
Several provisions have a retroactive effective date of 10/1/08. Pursuant
to 22 M.R.S.A. §42(8), the Department is authorized to adopt rules with
retroactive application when, as here, it is necessary to maximize available
revenue sources, and there is no adverse financial impact on any MaineCare
provider or member.<o:p></o:p></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'><o:p> </o:p></span></font></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:11.0pt'>These rules permanently adopt emergency rules,
effective February 21, 2009, that reduce hospital-based physician reimbursement
to 46.21% of costs, which is the closest to 70% of the Medicare fee schedule
that the Department could fund with the resources used for physician
reimbursement, as adjusted by the Supplemental Budget, which reduced
reimbursement by $1,947,490 of state dollars. A percentage of costs is
being used to calculate 70% of the Medicare fee schedule absent
claims—based data. Prospective Interim Payments (PIP) will be
lowered in an amount corresponding to the anticipated hospital-based physician
payment reimbursement, which are paid separately and not paid as part of
PIP. Permanent adoption of this methodology change will be contingent
upon approval by the U.S. Center for Medicare and Medicaid Services (CMS).<o:p></o:p></span></font></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'><o:p> </o:p></span></font></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:11.0pt'>Two proposed changes were withdrawn as a result of
comments and legislative action. The provision for hospitals to report
professional services on a CMS 1500 form separate from facility fees was
withdrawn due to a moratorium enacted by Congress. Also, the
reimbursement of non-emergency room hospital-based physicians at 70% of the
Medicare fee schedule was withdrawn due to contrary pending legislation in the
1<sup>st</sup> session of the 124<sup>th</sup> Legislature. Two links
were updated in Chapter II, Section 45.11 and Section 45.12.<o:p></o:p></span></font></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'><o:p> </o:p></span></font></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:11.0pt'>This rulemaking does not adversely impact counties or
municipalities, and it does not adversely impact small businesses of twenty
(20) or fewer employees because the service affected by the rate reduction is
not provided by small businesses.<o:p></o:p></span></font></p>
<p class=MsoBodyText2><font size=2 face="Times New Roman"><span
style='font-size:10.0pt'><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'>EFFECTIVE DATE:</span></font></b><font
size=2><span style='font-size:11.0pt'>
May 23, 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><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'> <font
color=navy><span style='color:navy'>Derrick Grant</span></font>, 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'>TELEPHONE:</span></b>
(207)-287-6124 FAX: (207) 287-9369<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.5in'><font size=2 face="Times New Roman"><span
style='font-size:11.0pt'>
TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing)<o:p></o:p></span></font></p>
<h3 style='margin-bottom:0in;margin-bottom:.0001pt'><b><u><font size=2
face="Times New Roman"><span style='font-size:11.0pt;font-family:"Times New Roman";
font-weight:normal'>______________________________________________________________________________</span></font></u></b><font
size=2 face="Times New Roman"><span style='font-size:11.0pt;font-family:"Times New Roman"'><o:p></o:p></span></font></h3>
<h3><a name="_CHAPTER_NUMBER_AND"></a><b><font size=2 face="Times New Roman"><span
style='font-size:11.0pt;font-family:"Times New Roman"'>CHAPTER NUMBER AND
TITLE: MaineCare Benefits Manual, Chapter III, Section 97, and Appendices
B, D, E, and F, Private Non-Medical Institution Services<o:p></o:p></span></font></b></h3>
<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 style='margin-right:31.5pt'><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'> These
rules permanently adopt emergency rules already in place that have recently
been approved by the Maine State Legislature in LR 1883(03).<b><span
style='font-weight:bold'> </span></b>The rules eliminate bedhold day
reimbursement for PNMI services. Specific changes in these rules include
that bedhold day codes are eliminated from Chapter III, including BQL, BRL,
MRPL, RHL RHL9, RML RML2, RTSL, and PL. Some language regarding occupancy
rates was also eliminated from Appendices B, D, E, and F. The Department
also replaced some local codes with HIPAA-compliant standard codes that will
not be implemented until further notice when the new claims system is
operating. Providers will be given prior notice of the change for these billing
codes. <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><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'>
June 15, 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'>Patricia Dushuttle, Manager, <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'>
287-9362<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 Division of Policy posts <a
href="http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html">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>
<div style='border:none;border-bottom:solid windowtext 1.0pt;padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<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><o:p></o:p></p>
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