Proposed Rules

May 29, 2012

Listed below are recently proposed and adopted rules. You can access the complete rule go to the MaineCare Webpage.

RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services

CONCISE SUMMARY: This rulemaking seeks to permanently adopt changes already made on an emergency basis. The rule updates the supplemental pool amount and method for distributing that pool to Non-Critical Access and other hospitals to better align with Diagnosis Related Group reimbursement. Effective April 24, 2012, the Department is decreasing the supplemental pool for Non-Critical Access, Rehabilitation Hospitals and Hospitals Reclassified to a Wage Area Outside Maine from $51,847,218 to $51,642,035. The distribution methodology for that pool is also being amended from a system based solely on the relative share of MaineCare discharges to one that also uses the relative share of MaineCare days. The Department is also making caps on Prospective Interim Payments (PIP) consistent across the system so that the total payment to all hospitals receiving a PIP is not less than 70% of the calculated amount of the total PIP for the current year.

This proposed rulemaking, beyond seeking to permanently adopt changes already made on an emergency basis, will also seek to end reimbursement for certain Provider Preventable Conditions (PPC), as defined by Medicare and federally required by the Patient Protection and Affordable Care Act. The DHHS will be seeking CMS approval of the State Plan for these changes.

See the MaineCare webpage for rules and related rulemaking documents.

STATUTORY AUTHORITY: 22 M.R.S.A. 42, 3173; Patient Protection and Affordable Care Act (Pub. L. No. 111-148 as amended by the health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152), together known as the Affordable Care Act, Section 2702, as implemented in federal Medicaid regulations, 42 CFR Sections 436.6, 438.6 and 447.26.

PUBLIC HEARING: Date: May 31, 2012 9:30 AM Location: Conference Room # 111B 19 Union Street Augusta, ME

DEADLINE FOR COMMENTS: Comments must be received by midnight June 10, 2012.

AGENCY CONTACT PERSON: Derrick Grant, Comprehensive Health Planner AGENCY NAME: MaineCare Services ADDRESS: 11 State House Station 242 State Street Augusta, Maine 04333-0011

TELEPHONE: 207-287-6427 FAX: (207) 287-9369 TTY: 711 (Deaf or Hard of Hearing) _____________________________________________________________________________ _

RULE TITLE OR SUBJECT MaineCare Benefits Manual, Chapters II & III, Section 65, Behavioral Health Services

CONCISE SUMMARY: This rule is being proposed, in part, to comply with Public Law 2011, Chapter 477, LD 1816 (the Maine State Supplemental Budget) passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 26, 2012. Parts of this rule are being proposed in accordance with Part M of said Budget requiring that MaineCare Services reduce reimbursement of Opioid Treatment (Methadone) from $72.00 per week to $60.00. This change is currently in effect through an emergency rule, effective April 1, 2012.

Additionally, this proposed rule includes changes from the general administrative savings portion of the Maine State Supplemental Budget. These proposed changes include the revision of several HCPC codes to CPT codes, which will allow Medicare crossover claims to be processed automatically, reducing the administrative burden for providers and the Department, thereby generating budgetary savings. It also includes language that will require a Mental Health Agency to employ or contract with an MD or DO to be the agencies’ Medical Director in order to be recognized by MaineCare as an agency and be reimbursed and paid at the higher agency rate. Those providers who do not employ a Medical Director and are currently enrolled and reimbursed at the higher agency rate will need to re-enroll as an Independent Practitioner and will be reimbursed at the lower Independent Practitioner rate.

Finally, this proposed rule also includes several changes that are not related to the Supplemental Budget, but are necessary to provide clarity to providers, remove outdated information and to achieve compliance with national correct coding standards.

PUBLIC HEARING: Date: June 4, 2012, 8:00 AM Location: Main Conference Room Department of Health and Human Services 221 State Street Augusta, ME

DEADLINE FOR COMMENTS: Comments must be received by midnight June 14, 2012.

AGENCY CONTACT PERSON: Amy Dix, Comprehensive Health Planner AGENCY NAME: MaineCare Services ADDRESS: 242 State Street 11 State House Station Augusta, Maine 04333-0011

TELEPHONE: 207-287-9342 FAX: (207) 287-9369 TTY: 711 (Deaf or Hard of Hearing) amy.dix@maine.gov

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CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 68, Occupational Therapy Services

CONCISE SUMMARY: This rule is proposed pursuant to Public Law 2011 ch. 477 sec. M-1, LD 1816 (the Maine State Supplemental Budget) passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 26, 2012. This rule is being proposed in accordance with Part M of said Budget requiring that MaineCare Services reduce reimbursement of Occupational Therapy Services by ten percent (10%) effective April 1, 2012.

PUBLIC HEARING: Date: June 4, 2012, 10 AM Location: Main Conference Room Department of Health and Human Services 221 State Street Augusta, ME

DEADLINE FOR COMMENTS: Comments must be received by midnight June 14, 2012.

AGENCY CONTACT PERSON: Amy Dix, Comprehensive Health Planner AGENCY NAME: MaineCare Services ADDRESS: 242 State St. 11 State House Station Augusta, Maine 04333-0011

TELEPHONE: 207-287-9342 FAX: (207) 287-9369 TTY: 711 (Deaf or Hard of Hearing) amy.dix@maine.gov

CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 85, Physical Therapy Services

CONCISE SUMMARY: This rule is proposed pursuant to Public Law 2011 ch. 477 sec. M-1, LD 1816 (the Maine State Supplemental Budget) passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 26, 2012. This rule is being proposed in accordance with Part M of said Budget requiring that MaineCare Services reduce reimbursement of Physical Therapy Services by ten percent (10%) effective April 1, 2012.

PUBLIC HEARING:

Date: June 4, 2012, 3:00 PM Location: Main Conference Room Department of Health and Human Services 221 State Street Civic Center Drive Augusta, ME

DEADLINE FOR COMMENTS: Comments must be received by midnight June 14, 2012.

AGENCY CONTACT PERSON: Amy Dix, Comprehensive Health Planner II/Policy Writer AGENCY NAME: MaineCare Services ADDRESS: 242 State St. 11 State House Station Augusta, Maine 04333-0011

TELEPHONE: 207-287-9342 FAX: (207) 287-9369 TTY: 711 (Deaf or Hard of Hearing)