Adopted Rulemaking

The MaineCare Benefits Manual (10-144, Department of Health and Human Services, Chapter 101) is available on the Secretary of State (SOS) website.

There is always a delay between the effective date the Office of MaineCare Services' adopts a rule and the date it is posted on the SOS website. Therefore, the Office of MaineCare Services posts recently adopted rules here until thay are posted on the SOS website.

Clarifications regarding adopted rules are also posted here.

*free viewer or to request a hard copy

 

Chapter 101, MaineCare Benefits Manual, Chapter III, Section32, Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF 
Concise Summary: This is a major substantive rule and will be final thirty days after it is filed. The Legislature approved the rule for final adoption in 2011-Resolve chapter 160, Regarding Legislative Review of Portions of Chapter 101, MaineCare Benefits Manual, Chapter III, Section 32, Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders, a major substantive rule of the Department of Health and Human Services. The final adopted rule establishes a section of the MaineCare Benefits Manual that is known as Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders. These services are provided to children under a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services (CMS). Services in Chapter II include Home Support, Home Accessibility Adaptations, Transportation, Consultation, Communication Aids and Respite Care. Chapter III establishes the rates for services. Services will be provided to children with Intellectual Disabilities or Pervasive Developmental Disorders to support them to live in the community rather than in institutional settings. This change is not expected to have an adverse economic impact on small businesses or municipalities and counties.
Effective Date: June 20, 2012
View Comments: WORD  Posted: May 24, 2012
 
Chapter 101, MaineCare Benefits Manual, Chapter II, Section 32, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF 
Concise Summary: The adopted rule establishes a new section 32.10 in Chapter II that provides for an increased level of home support where certain criteria of need are met. The Department added definitions in Section 32.02 for the terms “Behavioral Interventions,” “Restraint” and “Seclusion.” The Department added clarifying language to Section 32.03 regarding eligibility and priority and reordered some of the wording. Additionally, the Department added language specifying the individual cost limits for waiver services, as set forth in the waiver application approved by the Centers for Medicare and Medicaid Services. Other technical changes and formatting were also done. This change is not expected to have an adverse economic impact on small businesses or municipalities and counties
Effective Date: June 20, 2012
View Comments: WORD  Posted: May 24, 2012
 
MaineCare Benefits Manual Chapters II & III, Section 3, Ambulatory Care Clinic Services WORD  PDF 
Concise Summary: The adopted rules will consolidate and update all rules pertaining to the reimbursement of Indian Health Service (IHS) clinic services to one new section of MaineCare Benefits Manual (MBM) policy. Services provided by IHS providers are subject to different federal guidelines. Separation of these rules will clarify specific rules for IHS providers. The Department will also add guidelines for co-payment exemptions and tribal consultation to be in compliance with Section 5006(a) of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Public Law 111-5. Currently IHS services are included in MBM Section 3, Ambulatory Care Clinic Services. The Ambulatory Care Clinic Services section of the MBM will be amended at the same time as this rule-making in order to delete those portions that will now be part of Section 9, Indian Health Services.
Effective Date: March 21, 2012
View Comments: WORD  Posted: March 19, 2012
 
MaineCare Benefits Manual, Chapter II, Section 9, Indian Health Services WORD  PDF 
Concise Summary: The adopted rules will consolidate and update all rules pertaining to the reimbursement of Indian Health Service (IHS) clinic services to one new section of MaineCare Benefits Manual (MBM) policy. Services provided by IHS providers are subject to different federal guidelines. Separation of these rules will clarify specific rules for IHS providers. The Department will also add guidelines for co-payment exemptions and tribal consultation to be in compliance with Section 5006(a) of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Public Law111-5. Currently IHS services are included in MBM Section 3, Ambulatory Care Clinic Services. The Ambulatory Care Clinic Services section of the MBM will be amended at the same time as this rule-making in order to delete those portions that will now be part of Section 9, Indian Health Services.
Effective Date: March 21, 2012
View Comments: WORD  Posted: March 19, 2012
 
MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities WORD  PDF 
Concise Summary: This adopted rulemaking, if CMS approves, raises the Cost of Living Adjustment (COLA) for Nursing Facilities to 2% beginning on October 1, 2011. This is prompted by changes to P.L. 2011, ch. 411. The retroactive application of this rule is permitted under 22 MRSA 42(8).
Effective Date: March 3, 2012
View Comments: WORD  Posted: March 2, 2012
 
MaineCare Benefits Manual, Chapters II & III, Section 85, Physical Therapy Services WORD  PDF 
Concise Summary: This adopted rule will remove any differing requirements for school-based providers of MaineCare physical therapy services, and require them to meet all other requirements of comparable community-based providers of such services. In addition the Department clarifies that pursuant to 42 CFR §440.110, MaineCare physical therapy services must be prescribed by a physician or other licensed practitioner of the healing arts within the scope of practice under Maine law and must be provided by or under the direction of a qualified licensed physical therapist. Medical necessity for and the provision of these services to MaineCare members requires appropriate documentation. Each member’s written progress note must contain the start and stop time of the service. In Chapter III of this Section, billing modifiers TL and TM will be required for all services that are delivered under a Maine Department of Education Individualized Family Service Plan (IFSP) or an Individualized Education Plan (IEP), respectively
Effective Date: December 1, 2011
View Comments: WORD  Posted: November 16, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 109, Speech and Hearing Services WORD  PDF 
Concise Summary: : The Department of Health and Human Services is adopting this rule to remove any differing requirements for school-based providers of MaineCare speech and hearing services, and require them to meet all other requirements of comparable community-based providers of such services. In addition, the Department will clarify that medical necessity for these services requires appropriate documentation, and that provision of services must be documented. Each member’s written progress note must now contain the start and stop time of the service provided to the MaineCare member. Additionally, in this adopted rule the Department corrects multiple units of service in the Chapter III to move to HIPAA compliant coding in preparation for MIHMS federal certification, adds billing modifiers, and removes one redundant billing code. The Department’s Rate Setting unit carefully analyzed utilization to establish cost neutral reimbursement rates. These rates will be reevaluated in six months to assure members have access to these important services. To address public rate concerns in this final rule, the Department will allow providers to use the modifier 22 to gain additional reimbursement for Increased Procedural Services on all non-Evaluation and Management billing codes of this Section. Appending the modifier 22 will allow for manual claim review by the Department’s clinical staff or its authorized agent. If clinical documentation attached to the modifier 22 claim supports that substantial additional work was required, the provider will then receive an additional twenty percent (20%) reimbursement for that service to the MaineCare member. The following procedure codes 92526, 92550, 92565, 92568, 92610, V5364, V5364 TF, which were reimbursable historically, are added to MIHMS in this adopted rule and will be covered retroactively to 09/01/2010. Procedure codes 92585 and 96110 will be reimbursed by the Department going forward, as of the effective date of this rulemaking. In response to public comment, Ear Mold/Inserts (V5264) will have an increased reimbursement rate to 70% of the Medicare rate as of the effective date of this rulemaking. This adopted Chapter III also clarifies how some of the HIPAA compliant billing codes of this Section are state-level defined. (For example: Speech group therapy is defined as two to four MaineCare members with one clinician with appropriate documentation made for each individual in his/her medical record). Three (3) billing modifiers have been added to this Section for Departmental tracking purposes, as follows: TL will be required for services performed under an Individualized Family Service Plan (IFSP), TM will be required for all services delivered under an Individualized Education Plan (IEP) with the MaineCare addendum, and 52 (Reduced Services) will be required when a service is reduced or applied to one ear and not both. The Department made several technical corrections in the final rule, including changes in definition clarifications, grammar, punctuation and consistency of the format.
Effective Date: December 1, 2011
View Comments: WORD  Posted: November 16, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 68, Occupational Therapy Services WORD  PDF 
Concise Summary: This adopted rule removes any differing requirements for school-based providers of MaineCare occupational therapy services and requires them to meet all other requirements of comparable community-based providers of such services. In addition, the Department clarifies that pursuant to 42 CFR §440.110, MaineCare occupational therapy services must be prescribed by a physician or other licensed practitioner of the healing arts within the scope of practice under Maine law and must be provided by or under the direction of a qualified licensed occupational therapist. Medical necessity for and the provision of these services to MaineCare members requires appropriate documentation. Each member’s written progress note (also referred to as treatment or session note) must contain the start and stop time of the service. In this final rule the Department corrects that adult members are responsible for copayments up to $20 per month for Occupational Services. In Chapter III of this Section, billing modifiers TL and TM will be required for all services that are delivered under an Individualized Family Service Plan (IFSP) or an Individualized Education Plan (IEP) with the MaineCare Addendum for medical necessity, respectively.
Effective Date: December 1, 2011
View Comments: WORD  Posted: November 15, 2011
 
MaineCare Benefits Manual, Chapters II and III Section 13, Targeted Case Management Services WORD  PDF 
Concise Summary: The adopted rules eliminate two target groups currently being reimbursed under Chapter 13, Targeted Case Management (TCM): “Case Management Services for Children Involved with Protective Services”, and “Case Management Services for Adults Involved with Protective Services”. Additionally the rulemaking adds medical eligibility criteria for the target group “Members Experiencing Homelessness”. Chapter II is also changed to delete obsolete language concerning the 2009 transition to one Comprehensive Case Manager and add a requirement for documentation that members have had choice of providers. Chapter III is changed to align the standard units of service and maximum allowance for two categories of TCM services with the other TCM categories. These rule changes will not impose any cost on municipalities or counties or have any adverse impact on small businesses.
View Comments: WORD  Posted: October 31, 2011
 
MaineCare Benefits Manual, Chapter II, Section 32, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF 
Concise Summary: The adopted rule establishes a new section of the MaineCare Benefits Manual that is known as Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders. These services are provided to children under a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services (CMS). Services in Chapter II include Home Support, Home Accessibility Adaptations, Transportation, Consultation, Communication Aids and Respite Care. Services will be provided to children with Intellectual Disabilities or Pervasive Developmental Disorders to support them to live in the community rather than in institutional settings. This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: November 1, 2011
View Comments: WORD  Posted: October 27, 2011
 
MaineCare Benefits Manual, Chapter II, Section 60, Medical Supplies and Durable Medical Equipment WORD  PDF 
Concise Summary: The adopted rules add language indicating that providers may bill for up to a 72-day supply of incontinence supplies, which allows for increased ease of access for members residing in rural areas. The websites listed in the proposed rule were updated. Additionally, several prior authorization criteria were removed and providers were directed to the MIHMS provider portal for information regarding prior authorizations and criteria utilized by the Department. The Department received several comments suggesting that the inclusion of a secured website and proprietary medical criteria that members or their representatives are not able to access violates the Maine Administrative Procedures Act, Federal due process laws, as well as 42 CFR §§ 431.18 (Availability of agency program manuals) and a 1998 “Dear State Medicaid Director” letter from the Centers for Medicare and Medicaid Services. In order to address the commenters’ concerns, the Department has removed the proposed change of citation to this website and return those sections of the rule to their original state. Thus, the original MaineCare Services website and State developed medical criteria remain part of the adopted rule. The Department is working with its Medical Director to analyze criteria and to determine which prior authorizations can be removed and this will be addressed in a future rulemaking. The reimbursement methodology for miscellaneous Durable Medical Equipment and Medical Supplies has been revised to indicate that if a piece of Durable Medical Equipment or Medical Supplies has a nationally recognized code then that code must be used. If there is no code available a miscellaneous code must be used and a prior authorization must be submitted. Finally, a new requirement has been added to indicate that a face-to-face encounter by a physician, physician assistant, nurse practitioner or a clinical nurse specialist is required during the 6 months preceding the physician’s written order for Durable Medical Equipment. This federal law, the Patient Protection and Affordable Care Act (PL 111-148 §6407), is effective January 1, 2011.
Effective Date: October 24, 2011
View Comments: WORD  Posted: October 20, 2011
 
MaineCare Benefits Manual, Chapters II & III, Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorders WORD  PDF 
Concise Summary: This rule permanently adopts an emergency rule that became effective on July 1, 2011. The following changes were made in order to comply with the CMS approval of the waiver amendment and extension: Annual hourly limits for Community Support services were reduced from 1,300 to 1,125 hours. Annual hourly limits for Work Support services were increased from 300 to 600 hours. The combined annual hourly limit for when members use both Community Support and Work Support services was reduced to 1,125 from 1,300 hours. The Department has added Appendix III to Chapter II, which is composed of charts, to show how hours for the two services can be combined. The Department changed the name of both Chapters II and III of this Section, to Support Services for Adults with Intellectual Disabilities or Autistic Disorders, to match the name of the waiver, as approved by CMS. Substituting the terms “intellectual disability” for “mental retardation” also comports with P.L. 2009, ch. 571. Eligibility for Section 29 services includes the diagnoses of Asperger’s Syndrome, Pervasive Developmental Disorder (not otherwise specified), Autistic Disorder, Rett’s Disorder and Childhood Disintegrative Disorder. The Department corrected a typographical error in Chapter II: Limits on Respite Services was added to indicate that the Respite per diem rate is $90.00. The reduction from $100.00 to $90.00 was made in 2010 for Chapter III, but the Department did not make the corresponding change to Chapter II. Lastly, in Chapter III, procedure codes that are obsolete have been deleted. A public hearing was held on July 26, 2011. The comment deadline was August 5, 2011. This change is not expected to have an adverse impact on small businesses, or on counties or municipalities.
Effective Date: October 4, 2011
View Comments: WORD  Posted: September 30, 2011
 
MaineCare Benefits Manual, Chapter I, Section 2,State Medicaid Health Information Technology Program. WORD  PDF 
Concise Summary: This rule establishes policies for the Medicaid Health Information Technology (HIT) electronic health record (EHR) incentive payment program for Medicaid professionals and hospitals overseen by MaineCare Services (OMS). In order to be eligible, a professional or hospital must: 1) be of a certain type of professional or hospital and meet Medicaid or needy individual patient thresholds established for that type of professional or hospital as shown in Sections 1.04 and 1.05 of the rule; 2) adopt, implement or upgrade certified electronic health records before being approved for the first payment; and 3) meaningfully use the EHR before being approved for subsequent payments. The benefits to the participants are significant. An EP can receive a first year incentive payment of $21,250 for the initial adoption, implementation or upgrade of certified EHR technology. Upon establishing meaningful use of EHR technology, EPs will receive $8,500 in each of the next five payment years. The total amount of the EHR incentive payments for EPs over the six year payment period is $63,700. Based on a number of factors, Eligible Hospitals (EHs) receive $2,000,000 plus additional payments based on EHR incentives over a three (3) year period. Upon adopting, implementing or upgrading and establishing meaningful use of certified EHR technology, Eligible Hospitals receive 50% of the total incentive payment amount in the first year, 40% in the second year and 10% in the final third year. MaineCare will manage, administer and oversee the EHR Incentive Program for Medicaid providers as well as pursue initiatives that encourage the adoption of certified EHR technology and promote quality health care outcomes and data sharing. Members should benefit from improved health outcomes, increased patient safety, care coordination, increased efficiency and lower health care costs through meaningful use of EHR technology.
Effective Date: October 4, 2011
View Comments: WORD  Posted: September 30, 2011
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services WORD  PDF 
Concise Summary: The adopted rule moves acute care non-critical access hospitals to Diagnosis-Related Group (DRG) reimbursement methodology effective 7/1/2011 as reflected in the recent state budget, P.L. 2011, ch. 380. The supplemental pools for both critical and non-critical access hospitals are adjusted to reflect the conversion of one hospital to critical access status. The distribution methodology for the supplemental pool for non-critical access hospitals was changed to reflect the elimination of hospital specific discharge rates as part of the conversion to DRG methodology. Rehabilitation hospitals will be reimbursed under a fixed rate, per-discharge methodology instead of using a DRG-based methodology effective October 1, 2011. Language was added to DSH policy that allows Disproportionate Share Hospital (DSH) payments exceeding an individual hospital’s cap to be used for other hospitals to the extent allowable. Methodology for estimated payments made to state owned hospitals was clarified. The minimum level on outpatient prospective interim payments to acute care non-critical access hospitals and rehabilitation hospitals has been changed to 70%. There is now a separate section of rule for these hospitals. Rates for distinct psychiatric units were raised to previous levels effective October 1, 2011. See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Effective Date: September 28, 2011
View Comments: WORD  Posted: September 29, 2011
 
MaineCare Benefits Manual, Chapters II and III, Section 40, Home Health Services. WORD  PDF 
Concise Summary: This is permanent adoption of emergency rules that were effective September 1, 2010 and October 18, 2010 with additional changes resulting from the rulemaking process. These are changes to Major Substantive Rules and they were reviewed and approved by the Legislature in Resolve 2011, Chapter 100. The rule is changed to add requirements related to a face-to-face encounter between the Member and the physician or other designated provider who is certifying the medical necessity for home health service. Chapter II is changed to direct providers to the new website addresses for Center for Medicare and Medicaid Services definitions related to billing and for new billing instructions and billing codes for services and non routine medical supplies. The amendments to the rule add a new definition for “non routine medical supplies”, direct providers how to access the list of non routine medical supplies which can be reimbursed under Section 40 and create a process for adding to this list. The rule changes redefine the unit of service, making it consistent with the services associated with the new required HIPAA compliant codes. Chapter III is changed to provide the new HIPAA-compliant codes and the associated units of service that must be used by Home Health Services providers to bill for services.
Effective Date: September 1, 2011
View Comments: WORD  Posted: August 8, 2011
 
MaineCare Benefits Manual, Chapter II, Section 75, Vision Services WORD  PDF 
Concise Summary: The Department is adopting the following rule changes: (1) that prosthetics be provided only by ophthalmologist or optometrist, since opticians are not licensed to provide this service; (2) that prior authorization be deleted for tint, photochromatic or ultraviolet lenses; however, the Department is proposing to insert the medically necessary requirements for these lenses into the rule; (3) that the Department’s authorized agent be utilized for certain services; (4) that there is no one year warranty for normal wear and tear for articles purchased under the Vision Care Volume Purchase Contract (Contractor); (5) deleting the provision that allows providers to determine a need for repair/replacement of glasses/lenses; and (6) proposing that the Contractor be responsible for furnishing postage-paid mailers to providers for use in returning defective items to the Contractor. When providers use these mailers, the Contractor is solely responsible for the cost of items lost in transit; otherwise the provider assumes the financial responsibility. These rule changes do not have any adverse economic impact on municipal or county governments or small businesses.
Effective Date: August 25, 2011
View Comments: WORD  Posted: August 5, 2011
 
MaineCare Benefits Manual, Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder WORD  PDF 
Concise Summary: The Department is adopting a major substantive final rule, Chapter III, Section 21, Allowances for Home and Community Benefits for Adults with Intellectual Disabilities or Autistic Disorder. This final rule was approved by the legislature in Resolve Chapter 78. This rule will be effective 30 days after the final filing with the Secretary of State. The rule is being adopted pursuant to Resolve 2011, chapter 78. The Department also made technical changes to the rule to remove procedure codes that were effective for MECMS, the payment system that was effective prior to September 1, 2010.
Effective Date: September 1, 2011
View Comments: WORD  Posted: August 3, 2011
 
MaineCare Benefits Manual, Chapter III, Section 50, Principles of Reimbursement for Intermediate Care Facilities for the Mentally Retarded WORD  PDF 
Concise Summary: This rule permanently adopts a provisionally adopted major substantive rule which eliminates costs for Community Support Services (formerly called Day Habilitation Services) as part of the cost basis of the per diem rate for Intermediate Care Facilities for the Mentally Retarded. Instead, the rule refers providers to the reimbursement methods and rate for Community Support Services set forth in MaineCare Benefits Manual (MBM), Chapters II and III, Section 21. The amendment is made necessary by the repeal of MBM, Section 24, Day Habilitation Services. The amendment will also allow the billing code for this service to conform to federally required codes and the implementation of the Department’s new claims processing system. This change was adopted on an emergency basis effective April 1, 2010. The Legislature authorized the adoption of this rule on June 21, 2011. This rule change does not have any adverse economic impact on municipal or county governments or small businesses.
Effective Date: September 2, 2011
View Comments: WORD  Posted: August 3, 2011
 
MaineCare Benefits Manual, Ch III Section 97 Principles of Reimbursement for Private Non-Medical Institution Services, Appendix D: Child Care Facilities. WORD  PDF 
Concise Summary: This is permanent adoption of emergency rules that were effective October 1, 2010. The Department of Administrative and Financial Services quantified the General Fund fiscal problem as a potential shortfall of almost $400 million in the Governor’s initial proposed supplemental budget on December 18, 2009. The final supplemental budget enacted by the Legislature reflects a slight upturn in revenues and authorizes General Fund appropriations for the current biennium of approximately $5.53 billion. The Legislature has ordered various cuts in the MaineCare program in order to balance the budget, per PL 2009, c. 571. The reduction in reimbursement set forth in this rule was selected after careful consideration and it will be implemented in a fair and equitable manner. The Department was required to reduce fees paid to certain providers. Pursuant to the supplemental budget, PL 2009, ch. 571, Part A, §A-26 this rule specifies rate reductions for services under Section 97 Private Non-Medical Institution Services, Appendix D: Child Care Facilities. Additionally the rule eliminates one accounting requirement for providers that is no longer necessary, thereby reducing the administrative burden for providers. Effective July 1, 2011 the final rule additionally adjusts the rates to continue the savings for the following fiscal year. This is major substantive rulemaking and this adopted rule was reviewed and authorized by the legislature in Resolve of 2011, Chapter 98
Effective Date: September 1, 2011
View Comments: WORD  Posted: July 28, 2011
 
MaineCare Benefits Manual, Chapter II, Section 109, Speech and Hearing Services WORD  PDF 
Concise Summary: The Department of Health and Human Services is adopting this routine technical rule to clarify that unlicensed Speech and Language Clinicians holding a Certificate 293, as defined by the Maine Department of Education regulations Chapter 115 Part II, 2.6, are not qualified providers of MaineCare services. This rule change assures compliance with 42 CFR § 440.110. This rule change requires that speech language pathologists delivering medically necessary services in all settings, including schools, meet state licensure requirements.
Effective Date: July 1, 2011
View Comments: WORD  Posted: June 29, 2011
 
MaineCare Benefits Manual, Chapter III, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations WORD  PDF 
Concise Summary: The adopted rule provides a corrected rate for Specialized Services in Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations. The corrected rates are for services provided 1:1 (H2021 HK), groups with two patients served (H2021 HQ HK UN), groups with three patients served (H2021 HQ HK UP) and groups with four patients served (H2021 HQ HK UQ). There was an error in calculating the rates that are in place for Specialized Services; this adopted rule will correct that error. The Department adopts this rule change retroactive to September 1, 2010. This rule change will not have any adverse economic impact on counties, municipalities or small businesses.
Effective Date: June 11, 2011
View Comments: WORD  Posted: June 21, 2011
 
MaineCare Benefits Manual, Chapter II, Section 45, Hospital Services, Reporting Requirements WORD  PDF 
Concise Summary: The adopted rule will limit the quarterly reporting of outpatient claims for single source drugs and the top 20 physician-administered multiple source drugs as listed on a CMS website to the following hospitals: Acute Care Critical Access Hospitals, Private Psychiatric Hospitals and Hospitals Reclassified to a Wage Area Outside Maine by the Medicare Geographic Classification Review Board prior to October 1, 2008. Drugs purchased through Section 340B of the Public Health Act are exempt from this requirement.
Effective Date: June 15, 2011
View Comments: WORD  Posted: June 15, 2011
 
MaineCare Benefits Manual, Chapter III, Section 30, Allowances for Family Planning Agency Services WORD  PDF 
Concise Summary: The Department of Health and Human Services is adopting this rule to correct some units of service in the Chapter III of this Section to become HIPAA compliant as mandated by the Centers of Medicare and Medicaid Services (CMS) and, in preparation for the federal certification of Maine Integrated Health Management System (MIHMS). Based on an analysis of provider utilization, the Department has completed rate adjustments that remain cost neutral in the aggregate with the corrected HIPAA compliant codes and units of service. As of the effective date of this rule, Family Planning agencies will be reimbursed at the same fee for service rates as other providers of these services, including Section 90, Physicians Services. The Department will reevaluate these rates at least annually. Corrected lesion billing codes will be covered retroactively to September 1, 2010, to allow providers to bill these services accurately. Additionally, a “FP” billing modifier will now be required for all services performed exclusively to prevent or delay pregnancy or otherwise control family size. This modifier assures the State can properly track expenditures eligible for 90% Federal matching funds.
Effective Date: July 1, 2011
View Comments: WORD  Posted: June 15, 2011
 
MaineCare Benefits Manual, Chapter III, Section 85, Physical Therapy Services WORD  PDF 
Concise Summary: The Department of Health and Human Services is adopting this rule to correct some units of service in the Chapter III of Section 85 to become HIPAA compliant as mandated by the Centers of Medicare and Medicaid Services (CMS) and, in preparation for the federal certification of Maine Integrated Health Management Solution (MIHMS). Based on an analysis of provider utilization, the Department has completed rate adjustments that remain cost neutral with the corrected HIPAA compliant codes and units of service. Also, these changes result in all primary payers utilizing the same billing codes and units of service, assuring that MaineCare is indeed the payer of last resort.
Effective Date: July 1, 2011
View Comments: WORD  Posted: June 9, 2011
 
Chapter 101, MaineCare Benefits Manual, Chapter III Section 68, Occupational Therapy Services WORD  PDF 
Concise Summary: The Department of Health and Human Services is adopting this rule to correct some units of service in the Chapter III of Section 68 to become HIPAA compliant as mandated by the Centers of Medicare and Medicaid Services (CMS) and, in preparation for the federal certification of Maine Integrated Health Management System (MIHMS). Based on an analysis of provider utilization, the Department has completed rate adjustments that remain cost neutral with the corrected HIPAA compliant codes and units of service. Also, these changes result in all primary payers utilizing the same billing codes and units of service, assuring that MaineCare is indeed the payer of last resort.
Effective Date: July 1, 2011
View Comments: WORD  Posted: June 9, 2011
 
SPECIAL NOTICE-Reimbursement Policy Clarification and Overpayment Adjustments, MaineCare Benefits Manual, Chapter 101, Chapters II & III, Section 7, Free Standing Dialysis Services PDF   
Concise Summary: This letter is to provide policy and reimbursement clarification for Free Standing Dialysis Services and address overpayment adjustment options. It has come to our attention that there have been some reimbursement discrepancies with Free Standing Dialysis Services in the MIHMS claims system.
Effective Date: N/A
  Posted: June 8, 2011
 
MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services WORD  PDF 
Concise Summary: The adopted rules permanently adopt a modifier for Children’s’ Assertive Community Treatment (ACT)-HA for billing purposes to distinguish this service from Section 17 Community Support Services, Adult Assertive Community Treatment (ACT). The adopted rules also permanently adopt corrected rates for Collateral Services for Children’s Home and Community Based Treatment. The rate increase will be retroactive to July 1, 2010. Lastly, the adopted rules permanently adopt group ratio procedure codes for Children’s Behavioral Health Day Treatment. The new modifier and group ratio codes will be effective June 7, 2011. Lastly, the adopted rules permanently adopt group ratio procedure codes for Children’s Behavioral Health Day Treatment. The new modifier and group ratio codes will be effective June 7, 2011. Finally an HA modifier is added to three crisis services (H2011, H0018, S9482) as a technical correction, effective June 7, 2011.
Effective Date: June 7, 2011
View Comments: WORD  Posted: June 3, 2011
 
Ch. 101, MaineCare Benefits Manual, Chapter III, Section 68, Occupational Therapy Services WORD   
Concise Summary: This final rule is adopted pursuant to the supplemental budget, P.L. 2009, ch. 571, Sec. A-25 (pp. 70 & 72), which specifies a reduction in rates of 10 % for Occupational Therapy Services. The rule also includes a unit correction for evaluation and re-evaluation services to be consistent with national coding standards. This final rule permanently adopts the emergency rule that went into effect on July 1, 2010.
Effective Date: September 28, 2010
View Comments: WORD  Posted: September 28, 2010
 
Chapter 101, MaineCare Benefits Manual, Chapter III, Section 17, Community Support Services WORD   
Concise Summary: The final rules permanently adopt emergency rules that took effect 7/1/10. The rule adopted a 3% decrease in rates for Community Integration and a 4% decrease in all other services. The Department has an economic impact statement on file. Contact the person below for more information on the economic impact. This rule change will not have any impact on municipalities and counties.
Effective Date: September 28, 2010
View Comments: WORD  Posted: September 24, 2010
 
MaineCare Benefits Manual, Chapters II & III, Section 150 STD Screening Clinic Services Word   
Concise Summary: The adopted rules of Chapter II of Section 150 slightly increase provider reimbursement rate, add information on clinical record keeping, as well as update policy language to include the two additional provider-types of Certified Nurse Practitioners and Certified Nurse Midwives to align with other sections of MaineCare policy. Meanwhile, Chapter III Section 150 establishes a new billing procedure code based on HIPAA compliant CPT coding. Coding changes will take effect when the Department’s new claims processing systems (MIHMS) becomes operational, expected to occur in March 2010. Providers will be notified at least thirty (30) days prior to the effective date.
Effective Date: 2009-12-23
View Comments: Word  Posted: February 5, 2010
 

 

View Adopted Rule Archives