Section 65, Behavioral Health Update

March 23, 2012

This message is a follow up to the March 15, 2012 listserv about MaineCare Section 65 changes related to the DHHS Supplemental Budget.

Our original message indicated that the following changes will be in effect on April 1, 2012.

The Department will no longer implement these changes on that date. Instead, we will go through the proposed rulemaking process with an anticipated July 1, 2012 effective date for the two initiatives outlined below.

Transition Clinical Services in Section 65: Behavioral Health Agencies that do not employ a medical director must enroll as a group of providers, and get reimbursed at the rate as listed in .

The emergency adopted rules specify that only a provider who furnishes “Clinic Services,” as defined at 42 C.F.R. 440.90, by or under the direction of a physician may qualify as a Mental Health Agency. Some providers that were treated as Mental Health Agencies under the prior rules will not meet this definition. Such providers must reenroll as Behavioral Health Clinician Groups, and will be reimbursed at the Independent Practitioner rate.

Transition Section 65 to CPT codes: The Department will require that the codes Mental Health Agencies and Independent Practitioners use for Outpatient and Medication Management Services transition from the current H codes to the appropriate 9000 series codes. This will align with how providers bill and receive payment from Medicare, and will allow Medicare crossover claims to be processed automatically, reducing the administrative burden for providers and the Department.

Information on the rulemaking will be sent out via listserv in the near future.