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Bureau of Elder and Adult Services Department of Human Services 35 Anthony Avenue 11 State House Station Augusta, ME 04333-0011 Phone 207-624-5335 or 800-262-2232 FAX 207-624-5361 TTY 624-5442 or 888-720-1925 Memorandum

Section 96 of the MMAM becomes effective February 28, 2000. 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 have been made to the MED form to accommodate the calculation of eligibility for Medication administration /monitoring and Venipuncture services. To assist providers, BEAS has pulled together a packet of information that outlines the MED form changes. The instruction manual explains what Sections/pages of the MED form are required to be completed, and what section/ pages are submitted to the Department. The packet includes the following items:

1. Instructions for Completing the MED form: This booklet explains field by field how to complete the required sections of the form.
2. Samples of the completed MED form for 3 possible scenarios for Medication and Venipuncture only services. Use these as a reference tool.
3. The Revised MED form to be used as a template for copying: This is a copy that can be used to reproduce the pages required for these additional services. The MED form can also be copied for providers to use when assessing and determining eligibility for consumers under the age of 21 who want to access PDN/PCS services.
4. Copy of Section 96

For those consumers for whom you have been providing either Venipuncture services or Medication services for consumers with severe and disabling mental illness, since January 1,2000, a MED form needs to be completed and submitted to the Department.

Medicaid payment cannot occur until codes specific for these services are entered into Welfre. For any new consumers who need to receive these services, the applicable section/pages must be completed.

Required submission to BMS: The outcome page needs to be sent to the attention of Ginny Longley, Classification Review at BMS, State House Station 11, Augusta 04333. The fax number is 287-6533. Ginny will enter the appropriate codes into Welfre.

Feel free to contact me with questions.