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<p class=MsoNormal><a name="_top"></a><span style='font-size:12.0pt;font-family:
"Times New Roman","serif"'>This messag</span><span style='font-size:12.0pt;
font-family:"Times New Roman","serif"'>e is to give notice that emergency r</span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>ules </span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>for MaineCare
Benefits Manual Chapter II, Section 60, Medical Supplies and Durable Medical
Equipment </span><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>were
adopted on October 5, 2009.<b> </b>These rules were developed in
collaboration with provider representatives and the Maine DME association. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Adopted
rules are final and no changes can be made at this point. Emergency rules
remain in effect for 90 days. A regular rulemaking, including a public comment
period, will begin within the next 90 days. </span><span style='font-size:
12.0pt;font-family:"Times New Roman","serif"'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><a href="#_Adopted_Rule"><span style='font-size:12.0pt'>Adopted
Rule</span></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>
<o:p></o:p></span></p>
<p class=MsoNormal><a href="#_Procedure_Codes_and"><span style='font-size:12.0pt'>Procedure
Codes and Limit Details</span></a><span style='font-size:12.0pt;font-family:
"Times New Roman","serif"'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><a
href="#_Fee_Schedule"><span style='font-family:"Calibri","sans-serif"'>New DME
Fee Schedule</span></a> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<h2><a name="_Adopted_Rule"></a>Adopted Rule <o:p></o:p></h2>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>AGENCY:</span></b><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>
Department of Health and Human Services, MaineCare Services<o:p></o:p></span></p>
<p class=MsoNormal style='margin-right:.5in'><b><span style='font-size:12.0pt;
font-family:"Times New Roman","serif"'><o:p> </o:p></span></b></p>
<p class=MsoNormal style='margin-right:.5in'><b><span style='font-size:12.0pt;
font-family:"Times New Roman","serif"'>CHAPTER NUMBER AND TITLE</span></b><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>:
MaineCare Benefits Manual</span><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>,
Chapter </span><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>II,
Section 60, Medical Supplies and Durable Medical Equipment<b><o:p></o:p></b></span></p>
<p class=MsoNormal style='margin-bottom:.15in'><b><span style='font-size:12.0pt;
font-family:"Times New Roman","serif"'><o:p> </o:p></span></b></p>
<p class=MsoNormal style='margin-bottom:.15in'><b><span style='font-size:12.0pt;
font-family:"Times New Roman","serif"'>CONCISE SUMMARY: </span></b><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'> </span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif";color:black'>The
Department has determined that the immediate adoption of these rules is
necessary to assure that initiatives directed by the Maine State Legislature
are immediately implemented to achieve required savings in the budget law, in
accordance with PL 2009, ch. 213. The Legislature authorized the Department to
do emergency rulemaking in conjunction 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).<o:p></o:p></span></p>
<p class=MsoNormal style='margin-bottom:.15in'><span style='font-size:12.0pt;
font-family:"Times New Roman","serif";color:black'>Effective October 5, 2009
the Department is changing its reimbursement methodology so that it will
reimburse for DME/Medical Supplies as follows: (1) For DME/medical supplies
that are not “miscellaneous DME/medical supplies” or made available
through an exclusive contract with the Department, providers will be reimbursed
at the lower of: the Medicare rate, the providers usual and customary charge or
a MaineCare fee schedule published on the Department’s website. (2) For </span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'> DME/medical
supplies, which contains the phrase “miscellaneous,”
“accessories,” "not otherwise specified" or "not
otherwise classified" in its description, MaineCare will reimburse at
either the Manufacturers’ Suggested Retail Price (MSRP) minus twenty
percent (20%) or in cases where there is no listed MSRP, providers will be paid
their Usual and Customary Charges minus thirty percent (30%). (3) Where the
Department has entered into a contract with a supplier, the Department will
reimburse based on the priced contained in the contract. <o:p></o:p></span></p>
<p class=MsoNormal style='margin-bottom:.15in'><span style='font-size:12.0pt;
font-family:"Times New Roman","serif";color:black'>In addition, the Department
(1) will no longer provide coverage for non-sterile wipes for all MaineCare
members; (2) is placing limits on pressure mattress pads, commodes, walkers,
pneumonic compressor devices, apnea monitors, etc., (3) is defining criteria
for reclining wheelchairs; (4) is clarifying standards for phototherapy for the
treatment of seasonal affective disorder; and (5) is reducing the amount of
allowable incontinence supplies. <o:p></o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>EFFECTIVE
DATE:</span></b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>
October 5, 2009<b><o:p></o:p></b></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>AGENCY
CONTACT PERSON: </span></b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Nicole
Rooney, Health Planner<o:p></o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>AGENCY
NAME:</span></b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'> Division
of Policy and Performance<o:p></o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>ADDRESS:</span></b><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'> 442
Civic Center Drive<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'> 11
State House Station<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'> Augusta,
Maine 04333-0011<o:p></o:p></span></p>
<p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>TELEPHONE:</span></b><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>
(207)-287-4460 FAX: (207) 287-9369<o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:1.5in'><span style='font-size:12.0pt;
font-family:"Times New Roman","serif"'> TTY:
1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<h2><a name="_Procedure_Codes_and"></a>Procedure Codes and Limit Details <o:p></o:p></h2>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>In
the last DME rulemaking on 7/1/09, limits were set for incontinent supplies.
Previously, pull-ons were not included in the incontinent supplies limits. This
rulemaking applies a limit to pull-ons: 8 per day, the same limit as applies to
briefs. A member can get either pull-ons or briefs, but not both. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Non-sterile
Wipes are no longer covered with or without a PA. Procedure codes are </span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif";color:black'>A4335
and S5199.</span><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal style='mso-margin-top-alt:5.0pt;margin-right:0in;margin-bottom:
5.0pt;margin-left:0in'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Elastic
braces are also no longer covered; procedure codes are </span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif";color:black'>L0210,
L1800, L1815, L1825, L1901, L3651, L3652, L3700, L3701, L3909, L3911,
L0450, L0454, L0621, L0625, L0628. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Disposable
pads, liners etc are limited to 1 case of 150 per 36-day period. If the case
has more than 150, then the dealer needs to break it up. Or the dealer will
need to get prior authorization for the member to receive more than 150 in a
36-day period. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<h2><a name="_Fee_Schedule"></a>Fee Schedule <o:p></o:p></h2>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>The
new fee schedule for Section 60 will be published in the next two weeks.
Claims with dates of service after October 5, 2009 will be paid under the new
schedule. However, claims received and paid before the new fee schedule is
published may have to be adjusted later. Providers will get a notice about
claims adjustments. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>The
Division of Policy posts </span><a
href="http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html"><span
style='font-size:12.0pt'>all proposed and recently adopted rules</span></a><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'> 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 </span><a href="http://www.maine.gov/sos/cec/rules/10/ch101.htm"><span
style='font-size:12.0pt'>Secretary of State’s website</span></a><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>. <o:p></o:p></span></p>
<p class=MsoNormal>_______________________________________________________________________________<o:p></o:p></p>
<p class=MsoNormal><i><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>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></i></p>
<p class=MsoNormal><i><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></i></p>
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<p class=MsoNormal><i><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'> <o:p></o:p></span></i></p>
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