Attention Providers of Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations

On March 18, the Division of Licensing and Certification (DLC) sent notice that Section 28 providers are required to obtain a mental health license in order to provide Section 28 services due to the recently adopted CMR 10-144 Chapter 123, Behavioral Health Organizations Licensing Rule. The notice included an application filing deadline of May 11, 2024, for providers who are not currently licensed as mental health agencies.  

REVISED - Medicare Standardization Rates for Calendar Year 2024 (CY24)

The Centers for Medicare & Medicaid Services (CMS) has revised its rates effective March 9, 2024. To align with these changes, the Department is in the process of updating reimbursement rates for Medicare covered codes and services for the sections noted below. The new rates will reflect 72.4% of the most recent, 2024 Medicare rates.   

Evergreen Users Billing 837 Claims

With the new Evergreen system rollout, previous authorizations with a prefix of “EIS” have been replaced by new authorizations with a prefix of “LTS.”    

Our current Electronic Data Interchange (EDI) 837 file was developed with a max of 15 characters for authorization IDs. Some LTS authorization IDs were generated with a max of 17 characters. When submitting 837 claims, providers are reporting that the last two characters of the 17-character authorization ID are getting cut off, resulting in denied claims with the “UM not found” edit.    

Palliative Care Interdisciplinary Team Services (Section TBD) – Rate Study Kickoff Presented Materials

On March 27, 2024, MaineCare held a virtual public meeting with interested stakeholders to present the Palliative Care Team (PCT) Services Draft Model and provide an overview of a Staffing Survey for current palliative care providers. Stakeholders were able to ask questions and participate in an open discussion.  

10-144 CMR Ch 111, Temporary Nurse Agency Registration Rule

This new rule operationalizes the changes made to 22 MRS § 2313 under PL 2023 Ch 434. The rule reflects the following requirements of statute:

  • Increases the registration fee;
  • Places requirements for annual reporting on registered Temporary Nurse Agencies (TNAs);
  • Authorizes the Department to issue financial penalties to TNAs in certain circumstances;
  • Places record-keeping and access to records requirements on TNAs; and
  • Establishes employee quality assurance measures for TNAs.

Attention Primary Care Plus (PCPlus) Practices: Reminder - PCPlus Open Office Hour 

The Delivery System Reform Unit (DSRU) will be holding a PCPlus Open Office Hour on Friday April 5th , 2024 from 12 – 1pm. The purpose of the Open Office Hour is to provide an accessible online venue for PCPlus providers to come and ask MaineCare questions you might have regarding the PCPlus program. If you have any questions about the PCPlus application process, this also a great opportunity to ask those questions. 

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