Clarification: Section 65, Behavioral Health Services

September 3, 2013

We had previously communicated that, effective August 1, 2013, MaineCare members who are dually eligible for both Medicaid and Medicare must receive services from a Licensed Clinical Social Worker (LCSW) instead of Licensed Clinical Professional Counselors (LCPC) or Licensed Marriage and Family Therapists (LMFT) without obtaining an exception in writing from the Director of MaineCare Services. This is in accordance with Chapter 1, which ensures a member’s primary coverage is maximized and MaineCare is the payer of last resort. In addition to a LCSW, dual eligible members may seek outpatient Behavioral Health services from psychiatrists, other doctors, or clinical psychologists who accept Medicare payments.

When there is an extenuating circumstance, or the travel distance is beyond 30 minutes to see a Medicare participating provider, some members may continue to see their current LCPC/LMFT by requesting an exception in writing to the Director of MaineCare Services. It can be mailed to: Department of Health and Human Services, 11 State House Station, Augusta, ME 04333-0011. When the member is requesting an exception, please continue to provide services and submit your claims to MaineCare. You will be copied on the response to the member advising of the determination following review of the exception request.