Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 71, National Diabetes Prevention Program Services
NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment to implement coverage and reimbursement for the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP) which is comprised of twenty-two sessions delivered over the course of one year. The first sixteen core sessions occur during the first six months and the final six maintenance sessions occur monthly during the last six months.
Methodologies for each session and performance payment are as follows:
A. Session Rate. The allowed amount for each National DPP LCP session is 100% of Medicare’s current total reimbursement for all sessions without weight loss included in the Medicare Diabetes Prevention Program (MDPP) divided by the total number of sessions required by the most current version of the CDC Diabetes Prevention Recognition Program Standards and Operating Procedures (DPRP Standards).
B. Performance Payment. The allowed amount for each performance payment is 100% of Medicare’s current maximum reimbursement for additional payments related to weight loss in the MDPP divided by two (2).
Providers are also eligible for two performance payments if members achieve weight loss or HbA1C goals. The allowed amount for each performance payment is 100% of Medicare’s current maximum reimbursement for payments related to weight loss included in the MDPP divided by two.
REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2021, Ch. 398, Part A, Sec. A-17.
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $1,194,468 in federal fiscal year 2024 which includes $750,759 in federal funds and $443,708 in state funds, and will cost $1,506,389 in federal fiscal year 2025 which includes $942,849 in federal funds and $563,540 in state funds.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call
CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE:
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
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