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|
Angus S. King, Jr. |
State of Maine |
Kevin W. Concannon |
| February 22, 2000 |
| TO: | Interested Parties |
| FROM: | Francis T. Finnegan Jr., Director, Bureau of Medical Services |
| SUBJECT: | Final Rules:Chapters II and III, Section 96, Private Duty Nursing & Personal Care Services, Maine Medical Assistance Manual |
Attached, please find a copy of the final rules: Chapters II and III, Section 96, Private Duty Nursing & Personal Care Services, Maine Medical Assistance Manual. Coverage of newly adopted eligibility criteria, covered services and rates of reimbursement shall be effective for services delivered on or after January 1, 2000.
Changes adopted in these final rules include, but are not limited to the following: 1) New procedure codes and rates of reimbursement in Chapter III. 2) Eligibility requirements for the "Extended Level" of care are specified. 3) Two new covered services and eligibility criteria for those services are adopted: venipuncture services and medication services for the treatment of severe and disabling mental illness. 4) A once a month nursing assessment services has been added to the "At Risk" level of care. 5) The scope of personal care services is expanded to include necessary grocery shopping. 6) Under Sec. 96.03 Duration of Care, new criteria are adopted which specify when services can be denied, reduced, or terminated. Criteria for the recipient's classification period are clarified. 7) A section on recipient appeals is adopted. 8) Under Section 96.07 Reimbursement, language is added which specifies that a Home health Care provider must be a licensed agency in order to bill agency rates. Finally, 9) Individuals receiving services under the Waiver program for Persons with Mental Retardation may now also access covered nursing services, when determined medically eligible for these services.
The Private Duty Nursing Services provider shall determine a recipient's medical eligibility for coverage under Section 96.02-4(D) Medication Services for Severely Mentally Disabled Persons, as well as Section 96.02-4(E) Venipuncture Services, according to the requirements of these sections. The Department has revised the Medical Eligibility Determination (MED) form (and instructions) to include these new services. In order to receive coverage, the PDN provider must submit the MED form to the Classification Review Unit, Bureau of Medical Services.
For all other PDN services for individuals age 21 and over, medical eligibility determinations shall continue to be conducted by the Department's Assessing Services Agency, Goold Health Systems. Medical eligibility determinations for children and individuals under the age of 21 years, shall continue to be conducted by the PDN provider.
The current program "caps" provided for under Section 96.03 are as follows: "At Risk" level of care $1000/month; "Nursing Facility" level of care (available only to individuals under age 21) $3,521/month; and "Extended" level of care $208,827/year.
A public hearing on these rules was held on November 30, 1999. Written comments regarding these rules were accepted through December 10, 1999. All public comments were considered and where appropriate incorporated into these final rules. A summary of the comments and the Department's responses may be obtained by contacting Debbe Sullivan at 624-5521. If you have any questions regarding these final rules, please contact your Provider Relations Specialist at 287-3094 or 1-800-321-5557, Option 1. (For TTY call 287-1828 or 1-800-423-4331.)
FTF/jct
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