Maine Medicaid State Plan

The Maine Medicaid State Plan outlines how the Medicaid program is implemented in Maine. The State Plan covers many topics, from program administration to reimbursement, and is updated regularly through State Plan Amendments.  The Centers for Medicare and Medicaid Services (CMS) is the federal agency responsible for overseeing the Medicaid program in each state, including approval of changes to the State Plan. Please visit the CMS Medicaid State Plan Amendment site for a complete searchable listing of Maine's recently approved State Plan Amendments.

Methodology / Public Notices

MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 11-13-19 WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment in the near future to amend the following: SUPPLEMENTAL POOL FOR NON CRITICAL ACCESS HOSPITALS, HOSPITALS RECLASSIFIED TO A WAGE AREA OUTSIDE MAINE AND REHABILITATION HOSPITALS: The Department plans to increase the total inpatient and outpatient supplemental pool for the privately owned and operated Acute Care Non-Critical Access hospitals, hospitals reclassified to a wage area outside Maine by the Medicare Geographic Classification Review Board, and rehabilitation hospitals. Effective November 14, 2019, the total pool amount will increase to $80,575,379. Of the $80,575,379, up to $42,481,159 will be allocated to inpatient services and up to $38,094,220 will be allocated to outpatient services. Effective November 14, 2020 the total pool amount will increase to $80,914,112. Of the $80,914,112, up to $42,819,892 will be allocated to inpatient services and up to $38,094,220 will be allocated to outpatient services. The allocated inpatient pool amount will be distributed based on each hospital's relative share of inpatient MaineCare payments, defined as the hospitals inpatient MaineCare payment in the applicable state fiscal year divided by inpatient MaineCare payments made to all privately owned and operated Acute Care Non-Critical Access hospitals, hospitals reclassified to a wage area outside Maine by the Medicare Geographic Classification Review Board, and rehabilitation hospitals, multiplied by the supplemental pool amount. For state fiscal years beginning on or after July 1, 2019 but before July 1, 2021, the hospital's taxable year is the hospitals fiscal year that ended during calendar year 2016. Each hospital in the pool will receive its relative share of this supplemental payment. Supplemental payments will be distributed semiannually in November and May. This pool will be decreased by the amount a hospital would have received if that hospital was in the pool when the total pool amount was set but subsequently became an approved critical access hospital. This supplemental pool payment is not subject to cost settlement. ACUTE CARE CRITICAL ACCESS HOSPITALS AND HOSPITAL RECLASSIFIED TO A WAGE AREA OTUSIDE MAINE BY THE MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD (MGCRB) PRIOR TO OCTOBER 1, 2008: Additionally, effective November 14, 2019, the Department plans to increase the total inpatient pool for privately owned and operated critical access hospitals only, not those hospitals reclassified to a wage area outside Maine by the Medicare Geographic Classification Review Board or public hospitals, from $4,000,000 to $5,613,061. Effective November 14, 2020, the total inpatient pool for privately owned and operated critical access hospitals will increase from $5,613,061 to $5,672,482. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2019, ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $10,808,368 in federal fiscal year 2020: $6,353,002 will be federal expenditures and $4,455,366 will be state expenditures. This change will result in an increase of $11,206,522 in federal fiscal year 2021: $6,511,780 will be federal expenditures and $4,694,742 will be state expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: November 20, 2019 Posted: November 13, 2019
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 09-26-19 WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: Beginning October 1, 2019, the Department of Health and Human Services shall provide reimbursement to hospitals other than acute care critical access hospitals for each day after the 10th day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The Department shall reimburse hospitals at the statewide average rate per MaineCare member day for nursing facility services. The Department shall compute the statewide average rate per MaineCare member day based on the simple average of the nursing facility rate per MaineCare member day for the applicable state fiscal year, or years prorated for the hospital's fiscal year. Reimbursement for days awaiting placement pursuant to this section is limited to a maximum of $500,000 of combined State General Fund funds and federal funds for each year for a period of five years. The Department will reimburse quarterly by order of claim date. In the event the cap is expected to be exceeded in any quarter, reimbursement for claims in that quarter will be paid out proportionately, and a notification of total funds expended for that year will be sent out to providers. This provision is repealed December 31, 2023. REASON FOR PROPOSED CHANGES: All changes are pursuant to P. L. 2017, ch. 454, An Act to Require Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates this will cost approximately $99,244 in SFY 2020, which includes $35,390 in state dollars and $63,854 in federal dollars and approximately $99,244 in SFY 2021, which includes $35,390 in state dollars and $63,854 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: October 3, 2019 Posted: September 26, 2019
 
MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services 09-24-19 WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to increase the total inpatient and outpatient supplemental pool amount by $10,808,368. The total pool amount will increase to $82,188,440. Of the $82,188,440, up to $44,094,220 will be allocated to inpatient services and up to $38,094,220 will be allocated to outpatient services. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2019, ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost a total of $82,188,440 in each federal fiscal year 2020 and 2021; $29,752,216 will be state expenditures and $52,436,224 will be federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: October 1, 2019 Posted: September 24, 2019
 
MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services NATURE OF PROPOSED CHANGES: The Department previously requested approval from the Centers for Medicare and Medicaid Services (CMS) for changes to the reimbursement of Opioid Health Home (OHH) Services. The proposed changes included the addition of a tiered rate structure as identified below. This revised notice provides information at the request of CMS to clarify the amounts specific to the six Health Homes services and the tiered rate structure. *All payments go to the OHH. All OHHs have capacity to deliver all 6 health home services and receive the payment for these services. Non-health home services are covered in other approved state plan pages and are not duplicative of health home services. Rates are based on member acuity. For individuals receiving Tier 1 services, the full Per Member Per Month (PMPM) payment that covers the section 2703 health home services is $394.40. To be eligible for Tier 1 services, members must have an opioid use disorder and have a second chronic condition or be at risk of a second chronic condition consistent with the Maine Opioid Health Home SPA approved Executive Summary and Population Criteria. For individuals receiving Tier 2 services, the full PMPM payment that covers the 2703 health home services is $409.40. This acuity level is for members with chronic condition management needs when partnering with an enhanced primary care practice. To be eligible for Tier 2 services the member must meet the eligibility criteria for Tier 1 AND they must also be diagnosed with two (2) or more of the following chronic conditions, OR one (1) chronic condition AND be at risk for another chronic condition as indicated below: Chronic Conditions: 1. a mental health condition; 2. a substance use disorder; 3. tobacco use; 4. diabetes; 5. heart disease; 6. overweight or obese as evidenced by a body mass index over 25; 7. Chronic Obstructive Pulmonary Disease (COPD); 8. hypertension; 9. hyperlipidemia; 10. developmental and intellectual disorders; 11. circulatory congenital abnormalities; 12. asthma; 13. acquired brain injury; and 14. seizure disorders. At Risk for Another Chronic Condition: 1. A member is deemed to be at risk for another chronic condition if the member has been diagnosed with any of the following: a. a mental health condition; b. a substance use disorder; c. tobacco use; d. diabetes; e. heart disease; f. overweight or obese as evidenced by a body mass index over 25; g. chronic obstructive pulmonary disease (COPD); h. hypertension; i. hyperlipidemia; j. developmental and intellectual disorders; or, k. circulatory congenital abnormalities Of the PMPM, the OHH may pass through $15 to the enhanced primary care practice partner. For individuals receiving Tier 3 services the full PMPM payment that covers the section 2703 health home services is $534.49. This acuity level is for members with additional community support needs related to mental health, HIV, and homelessness. To be eligible for Tier 3 services a member must have an opioid use disorder and have a second chronic condition or be at risk of a second chronic condition consistent with the Maine Opioid Health Home SPA approved Executive Summary and Population Criteria and must also be diagnosed with a Serious and Persistent Mental Illness (SPMI), Serious Emotional Disturbance (SED), HIV or experiencing homelessness. Of the PMPM, the OHH may pass through $394.40 to the additional community support team members. REASON FOR PROPOSED CHANGES: The Department is issuing this revised notice at the request of CMS to further clarify the previous Notice of MaineCare Reimbursement Methodology Change issued September 27, 2018 for MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $4,951,297 in State Fiscal Year (SFY) 2019, which includes $1,173,978 in state dollars and $3,777,319 in federal dollars, and $15,299,506 in SFY 2020, which includes $5,131,753 in state dollars and $10,167,753 in federal dollars ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capital Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: July 17, 2019 Posted: July 10, 2019
 
MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services (MST/FFT) WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: In anticipation of the passing of LD 1809, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children (the "Resolve"), from the 129th Maine Legislature's first regular session-2019 the Department is issuing this notice to provide communication of the intent to submit a State Plan Amendment (SPA) for Section 65, Chapter III, Behavioral Health Services should this LD become law. This notice indicates our resulting intent to extend the 20% rate increase, pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government, for multisystemic therapy (MST), multisystemic therapy for problem sexualized behavior, and functional family therapy (FFT) services that was previously scheduled to end June 30, 2019. This extended increase of 20%, pursuant to the signing of the Resolve, will be effective July 1, 2019 through June 30, 2020. REASON FOR PROPOSED CHANGES: All changes are pursuant to LD 1809, Resolve, To Increase Funding for Evidence-based Therapies for Treating Emotional and Behavioral Problems in Children, from the 129th Maine Legislatures first regular session-2019. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will result in an increase of $697,624 in State Fiscal Year 2020, of which $262,306 is state expenditures and $435,318 is federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: July 5, 2019 Posted: June 28, 2019
 
MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services (MAT) WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Chapter III, Behavioral Health Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) to increase the reimbursement rate for Section 65, Chapter III, Behavioral Health Services Medication Assisted Treatment (MAT) effective July 1, 2019 to $110.00 per week. REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2019, ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $3,375,624 in State Fiscal Year 2020, of which $1,215,900 is state expenditures and $2,159,724 is federal expenditures. The Department anticipates that this change will result in an increase of $3,375,624 in State Fiscal Year 2021, of which $1,221,976 is state expenditures and $2,153,648 is federal expenditures. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 109 Capitol Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-6106 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: July 5, 2019 Posted: June 28, 2019
 
MaineCare Benefits Manual, Chapters II and III, Section 109, Speech & Hearing Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 109, Speech & Hearing Services NATURE OF PROPOSED CHANGES: The Department plans to increase reimbursement as follows: ·Agency rates at 69% of Medicare for codes 92507 (GN), 92521 (GN), 92522 (GN), 92523 (GN), 92607 (GN), 92608 (GN), 92609 (GN), and 92610 ·Adding Independent rates at 90% of Agency for codes 92507 (GN), 92507 (TF, GN), 92508 (HQ, GN), 92508 (TF, HQ, GN), 92521 (GN), 92522 (GN), 92523 (GN), 92524 (GN), 92526 (GN), 92607 (GN), 92608 (GN), 92609 (GN), and 92610 ·Adding Agency and Independent codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92547, 92548, 92570, 92611, 92612, and V5011 REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine Public Law 2017, ch. 60, Resolve, Regarding Reimbursement for Speech and Language Pathology. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $159,156 in SFY 2019, which includes $102,687 in federal dollars, and $636,622 in SFY 2020, which includes $409,157 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: January 18, 2019 Posted: January 11, 2019
 
MaineCare Benefits Manual, Section 15, Chapters II and III, Chiropractic Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 15, Chapters II and III, Chiropractic Services NATURE OF PROPOSED CHANGES: The Department plans to add coverage of certain evaluation and management codes for chiropractors, pursuant to Public Law 2017, ch. 421, An Act To Provide MaineCare Coverage for Chiropractic Treatment. The Department is limiting the evaluation codes to 99201-99215 for the purpose of examining and diagnosing a spinal condition; reimbursement of these codes and services will be located on the Maine Physicians’ fee schedule. Additionally, the Department is adopting changing the requirement of “subluxation” to “conditions” to align with Medicaid requirements. REASON FOR PROPOSED CHANGES: All changes are pursuant to Public Law 2017, ch. 421, An Act To Provide MaineCare Coverage for Chiropractic Treatment. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $84,351 in SFY 2019, which includes $29,928 in state dollars and $54,423 in federal dollars, and $253,054 in SFY 2020, which includes $89,784 in state dollars and $163,270 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: January 18, 2019 Posted: January 11, 2019
 
MaineCare Benefits Manual, Section 25, Dental Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 25, Dental Services NATURE OF PROPOSED CHANGES: The Department plans to request approval to amend coverage of dental services by including reimbursement of the following procedure codes at the rates listed below: PROCEDURE CODE DESCRIPTION AMOUNT D1516 space maintainer – fixed – bilateral, maxillary $220.00 D1517 space maintainer – fixed – bilateral, mandibular $220.00 D1526 space maintainer – removable – bilateral, maxillary $110.00 D1527 space maintainer – removable – bilateral, mandibular $110.00 D9944 occlusal guard – hard appliance, full arch $110.00 D9945 occlusal guard – soft appliance, full arch $110.00 D9946 occlusal guard – hard appliance, partial arch $110.00 D1354 Interim caries arresting medicament application – per tooth $24.74 REASON FOR PROPOSED CHANGES: These changes are being made to provide coverage for the services listed, when appropriate. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department expects that this rulemaking will save the Department approximately $7,368 in State Fiscal Year 2019 and $14,376 in State Fiscal Year 2020. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: January 2, 2019 Posted: December 21, 2018
 
MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services NATURE OF PROPOSED CHANGES: The Department of Health and Human Services plans to request approval from the Centers for Medicare and Medicaid Services (CMS) for a State Plan Amendment (SPA) related to reimbursement for drugs purchased through the pharmacy 340B drug pricing program. The 340B drug pricing program is outlined in 42 C.F.R. § 10. The State of Maine plans to reimburse for these drugs at the Average Sales Price (ASP) minus 22.5 percent. The State of Maine also plans to allow for 340B covered entities to carve out of the 340B drug pricing program. The State of Maine will also be requesting to remove the Rural Dispensing Fee Adjustment from the State Plan and Section 80 of the MaineCare Benefits Manual following the approval and implementation of the 2017 dispensing fee increase related to the New England States Consortium Systems Organization (NESCSO) pharmacy cost and dispensing survey. REASON FOR PROPOSED CHANGES: This change adds the 340B reimbursement methodology to the Maine State Plan in accordance with 42 C.F.R. § 10. Additionally, the State is seeking to remove the Rural Dispensing Fee Adjustment from the State Plan following the NESCSO survey and updated dispensing fee implementation. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that the costs of this rulemaking are unable to be determined at this time. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M. Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: December 30, 2018 Posted: December 19, 2018
 
MaineCare Benefits Manual, Section 45, Chapters II & III, Hospital Services WORD  PDF   
Concise Summary: Beginning January 1, 2019, the Department of Health and Human Services shall provide reimbursement to acute care non-critical access hospitals for each day after the 10th day that a MaineCare-eligible individual is in the care of a hospital while awaiting placement in a nursing facility. The Department shall reimburse hospitals at the statewide average rate per MaineCare member day for nursing facility services. The Department shall compute the statewide average rate per MaineCare member day based on the simple average of the nursing facility rate per MaineCare member day for the applicable state fiscal year, or years prorated for the hospital's fiscal year. Reimbursement for days awaiting placement pursuant to this section is limited to a maximum of $500,000 of combined State General Fund funds and federal funds for each year for a period of five years. This section will be repealed on December 31, 2023. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 454, An Act to Require Reimbursement to Hospitals for Patients Awaiting Placement in Nursing Facilities. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $49,622 in FY 2019, which includes $17,690 in state dollars and $31,932 in federal dollars. The rulemaking will cost approximately $99,244 in SFY 2020, which includes $35,390 in state dollars and $63,854 in federal dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: December 30, 2018 Posted: December 19, 2018
 
DRAFT of Maine Alternative Benefit Plan SPA Submission PDFof DRAFT SPA Submission      
Concise Summary: The Maine Department of Health and Human Services provides notice of its intent to submit a State Plan Amendment to define the Alternative Benefit Plan that will be used to allow for expansion of Medicaid eligibility to individuals aged 19‚€64 with incomes at or below 133 percent of the Federal Poverty Level who are not enrolled in or eligible for Medicare, consistent with the expanded eligibility criteria as defined by the Affordable Care Act, referred to here as the Adult Expansion Group. This ABP will be applicable to individuals in the Adult Expansion Group who are eligible for MaineCare. The Maine Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than December 31, 2018.Any comments regarding the proposed State Plan Amendment covered by this public notice, or requests for a written copy, may be submitted in writing to: Office of MaineCare Services, Division of MaineCare Policy, State House Station #11, 242 Water St., Augusta, ME 04333 or via email at Policy.DHHS@maine.gov. Written comments may be reviewed by the public at 242 State St, Augusta, ME 04330. Comments will be accepted until December 19, 2018. There is no public hearing scheduled.
Submit Comments (Opens in new window) Comment Deadline: December 19, 2018 Posted: November 30, 2018
 
MaineCare Benefits Manual, Section 40, Chapter III, Home Health Services Word  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 40, Chapter III, Home Health Services NATURE OF PROPOSED CHANGES: The Department plans to increase reimbursement rates for certain procedure codes. Effective January 1, 2019, the updated rate per 15-minute unit is as follows: • G0299 - $33.46; • G0300 - $23.42; • G0156 - $15.16; • G0152 - $36.83; • G0152 TF - $25.79; • G0151 - $36.58; • G0151 TF - $25.61; • G0153 - $39.75; • G0153 TF - $27.83; and • G0155 - $36.82 REASON FOR PROPOSED CHANGES: All changes are pursuant to Public Law 2017, Chapter 61, Resolves Reimbursement rate increase for home health services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in approximately $405,009, which includes $143,697 in state dollars and $261,312 in federal dollars for SFY 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill Kristin.Merrill@maine.gov AGENCY NAME: Office of MaineCare Services, 242 State Street, 11 State House Station, Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: December 2, 2018 Posted: November 21, 2018
 
PUBLIC NOTICE: State Plan Amendment regarding an Alternative Benefit Plan for an Expanded Adult Population WORD  PDF   
Concise Summary: PUBLIC NOTICE Maine Department of Health and Human Services Office of MaineCare Services State Plan Amendment regarding an Alternative Benefit Plan for an Expanded Adult Population The Maine Department of Health and Human Services provides notice of its intent to submit a State Plan Amendment, SPA, to define the Alternative Benefit Plan, ABP, that will be used to allow for expansion of Medicaid eligibility to individuals aged 19 - 64 with incomes at or below 133% of the Federal Poverty Level, FPL, who are not enrolled in or eligible for Medicare, consistent with the expanded eligibility criteria as defined by the Affordable Care Act referred to here as the "Adult Expansion Group". This ABP will be applicable to individuals in the Adult Expansion Group who are eligible for MaineCare, Maine's Medicaid program. The Maine Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than December 31, 2018. Once approved, the ABP will provide eligible individuals in the Adult Expansion Group with access to the federally mandated Essential Health Benefits. These Essential Health Benefits include the following services: Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health and substance use disorder services, including behavioral health treatment; Prescription drugs; Rehabilitative and habilitative services and devices; Laboratory services; Preventive and wellness services and chronic disease management; Pediatric services, including oral and vision care; Early and Periodic Screening, Diagnostic and Treatment, "EPSDT", services will be provided to those eligible individuals in the Adult Expansion Group who are under age 21 as required by law and regulation, and consistent with current state policy regarding the delivery of these services. Other covered services will include medically necessary services as prior authorized, as well as other services required to be covered pursuant to state or federal law, regulation, or policy. The "section 1937 coverage option" for the ABP will be "Secretary-Approved Coverage" that is based on, and consistent with, the benefits provided in Maine's approved state Medicaid plan. The "base benchmark plan" will be the largest plan by enrollment of the three largest small group insurance products in Maine's small-group market. Consistent with federal law and the Maine Medicaid State Plan, the State Plan, the State Medicaid Director will provide written notice regarding this proposed State Plan Amendment to the appropriate tribal contacts on November 19, 2018. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.
Submit Comments (Opens in new window) Comment Deadline: December 19, 2018 Posted: November 19, 2018
 
MaineCare Benefits Manual, Chapters II and III, Section 67, Nursing Facility Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapters II and III, Section 67, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) for Section 67, Chapters II and III, Nursing Facility Services related to: 1. Special wage allowance for fiscal year 2018-19. For the state fiscal year ending June 30, 2019, a special supplemental allowance must be made to provide for increases in wages and wage-related benefits in both the direct care cost component and routine care cost component as follows: the allocated amount, up to 10%, of allowable wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. 2. Changes in occupancy penalty. For the state fiscal years ending June 30, 2019, June 30, 2020 and June 30, 2021, the reduction in allowable cost per day in the fixed costs component based on minimum occupancy standards applies only for an annual level of occupancy less than 70%. For fiscal years ending June 30, 2022 and thereafter, the reduction in allowable cost applies only for an annual level of occupancy less than 85% for facilities with 61 or more beds and 80% for facilities with 60 or fewer beds. 3. Low-cost, high Medicaid nursing facilities. Beginning July 1, 2019, the supplemental payment established by Public Law 2013, chapter 594, section 3, subsection 5 must be revised to provide that the supplemental payment increase to 60¢ per resident day, is not subject to cost settlement and must be retained by the facility in its entirety for any nursing facility whose MaineCare residents constitute more than 80% of the nursing facility's total number of residents and whose base year direct and routine aggregate costs per day are less than the median aggregate direct and routine allowable costs for the facility's peer group. The supplemental payment must continue to apply as provided in Public Law 2013, chapter 594, section 3, subsection 5 for facilities that do not meet the standard set forth in this subsection. 4. Establish a nursing facility's base year. For the state fiscal year beginning July 1, 2018, the base year for each facility is its fiscal year that ended in the calendar year 2016. For state fiscal years beginning on or after July 1, 2019, subsequent rebasing must be based on the most recent cost report filings available. Beginning in the state fiscal year beginning July 1, 2018, the rates set for each rebasing year must include an inflation adjustment for a cost-of-living percentage change in nursing facility reimbursement each year in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index. Any rebasing done pursuant to this paragraph may not result in a nursing facility receiving a reimbursement rate that is lower than the rate in effect on June 30, 2018. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government, ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $18,467,741 in State Fiscal Year 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: October 3, 2018 Posted: September 27, 2018
 
MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 93, Opioid Health Home Services NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services for changes to the reimbursement of Opioid Health Home Services. The proposed changes include the addition of a tiered rate structure for Intensive Outpatient Therapy, Intermediate/Stabilization, and Maintenance levels of treatment. Additional adjustments are made for individuals receiving coordinated case management. REASON FOR PROPOSED CHANGES: Based on provider feedback, the previous rate structure was insufficient to cover the cost of delivering the services. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this rulemaking will cost approximately $2,519,842 in State Fiscal Year (SFY) 2019, which includes $143,787 in state dollars and $2,376,055 in federal dollars, and $6,880,534 in SFY 2020, which includes $1,749,958 in state dollars and $5,130,576 in federal dollars. The new rates are listed below: For individuals not receiving external coordinated case management services as described in 93.08(c): Intensive Outpatient Therapy (IOP) Level of Care: $2,217.76 per member per month Intermediate/Stabilization Level of Care: $1,045.01 per member per month Maintenance Level of Care: $662.68 per member per month. For individuals receiving coordinated case management as described in 93.08(c): Intensive Outpatient Therapy (IOP) Level of Care: $1,963.45 per member per month Intermediate/Stabilization Level of Care: $790.70 per member per month Maintenance Level of Care: $408.37 per member per month. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M. Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: October 7, 2018 Posted: September 27, 2018
 
MaineCare Benefits Manual, Chapters II and III, Section 67, Nursing Facility Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 67, Chapter II and III, Nursing Facility Services NATURE OF PROPOSED CHANGES: The Department plans to submit State Plan Amendment (SPA) for Section 67, Chapter II and III, Nursing Facility Services related to: 1. Special wage allowance for fiscal year 2018-19. For the state fiscal year ending June 30, 2019, a special supplemental allowance must be made to provide for increases in wages and wage-related benefits in both the direct care cost component and routine care cost component as follows. The allocated amount, up to 10%, of allowable wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in that fiscal year. 2. Changes in occupancy penalty. For the state fiscal years ending June 30, 2019, June 30, 2020 and June 30, 2021, the reduction in allowable cost per day in the fixed costs component based on minimum occupancy standards applies only for an annual level of occupancy less than 70%. For fiscal years ending June 30, 2022 and thereafter, the reduction in allowable cost applies only for an annual level of occupancy less than 85% for facilities with 61 or more beds and 80% for facilities with 60 or fewer beds. 3. Low-cost, high Medicaid nursing facilities. Beginning July 1, 2019, the supplemental payment established by Public Law 2013, chapter 594, section 3, subsection 5 must be revised to provide that the supplemental payment increases to 60¢ per resident day, is not subject to cost settlement and must be retained by the facility in its entirety for any nursing facility whose MaineCare residents constitute more than 80% of the nursing facility's total number of residents and whose base year direct and routine aggregate costs per day are less than the median aggregate direct and routine allowable costs for the facility's peer group. The supplemental payment must continue to apply as provided in Public Law 2013, chapter 594, section 3, subsection 5 for facilities that do not meet the standard set forth in this subsection. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government, Sec. B-3. Rate increases for nursing facilities ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $18,467,741 in State Fiscal Year 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml f
Submit Comments (Opens in new window) Comment Deadline: August 8, 2018 Posted: August 1, 2018
 
MaineCare Benefits Manual Chaper III, Sections 2, 13, 17, 23, 26, 28, 65, 97 Appendix C and 97 B and E. WORD  PDF   
Concise Summary: Chapter 101, MaineCare Benefits Manual, Section 2, Chapter III, Adult Family Care Services; Chapter 101, MaineCare Benefits Manual, Section 13, Chapter III, Targeted Case Management Services; Chapter 101, MaineCare Benefits Manual, Section 17, Chapter III, Community Support Services; Chapter 101, MaineCare Benefits Manual, Section 23, Chapter III, Developmental and Behavioral Clinic Services; Chapter 101, MaineCare Benefits Manual, Section 26, Chapter III, Day Health Services; Chapter 101, MaineCare Benefits Manual, Section 28 Chapter III, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations; Chapter 101, MaineCare Benefits Manual, Section 65, Chapters II and III, Behavioral Health Services; Chapter 101, MaineCare Benefits Manual, Section 97, Chapter III, Private Non-Medical Institution Services, Appendix C; Chapter 101, MaineCare Benefits Manual, Section 97, Chapter III, Private Non-Medical Institution Services, Appendix B and Appendix E; NATURE OF PROPOSED CHANGES: The Department plans to submit State Plan Amendments (SPAs) for the following: Section 2, Chapter III, Adult Family Care Services: For the state fiscal year ending June 30, 2019, the MaineCare payment rates attributable to wages and salaries for personal care and related services provided pursuant to each of the rules are increased by 10%. For the state fiscal year ending June 30, 2020 and each year thereafter until the completion of the rate study, the MaineCare payment rates attributable to wages and salaries for personal care and related services above must be increased by an inflation adjustment cost-of-living percentage change in reimbursement in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index. Section 13, Chapter III, Targeted Care Management Services: Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 17, Chapter III, Community Support Services: Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 23, Chapter III, Developmental and Behavioral Clinic Services: Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 26, Chapter III, Day Health Services: For the state fiscal year ending June 30, 2019, the MaineCare payment rates attributable to wages and salaries for personal care and related services provided pursuant to each of the rules are increased by 10%. Section 28, Chapter III, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations: The Department will establish reimbursement rates and increase existing reimbursement rates in accordance with the April 24, 2017 report Rate Study for Behavioral Health and Targeted Case Management Services: Final Proposed Rates for Formal Rulemaking prepared for the department by Burns & Associates, Inc. Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 65, Chapters II and III, Behavioral Health Services: The Department intends to increase rates by 15% for Medication Management services. Additionally, the Department intends to increase rates for multisystemic therapy (MST), multisystemic therapy for problem sexualized behavior and functional family therapy (FFT) services by 20% through June 30, 2019. Effective July 1, 2018, a net increase in funding from fiscal year 2008-09 to fiscal year 2018-19 of 2% as long as no rate for a service is lower than the rate reimbursed as of January 1, 2018. Section 97, Chapter III, Private Non-Medical Institution Services, Appendix C: For the state fiscal year ending June 30, 2019, a special supplemental allowance must be made to provide for increases in wages and wage-related benefits in the direct care, personal care services, and routine cost components as follows. An amount equal to 10% of wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 must be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance must also be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs in each component that is cost settled in that fiscal year. For the state fiscal year ending June 30, 2020 and each year thereafter, the MaineCare payment rates attributable to wages and salaries in each cost component specified in subsection 1 must be increased by an inflation factor in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index Section 97, Chapter III, Private Non-Medical Institution Services, Appendix B and Appendix E: to increase rates effective July 1, 2018 by 2% over the rates in fiscal year 2008-2009, provided rates do not decrease below those set as of January 1, 2018. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 460, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will result in an aggregate increase of $39,349,141 in State Fiscal Year 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: August 7, 2018 Posted: July 31, 2018
 
MaineCare Benefits Manual Chapter III, Sections 12 and 96 WORD  PDF   
Concise Summary: SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Allowances for Consumer Directed Attendant Services; and Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services; NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services to amend the rates of reimbursement for personal care and related services under both Chapter 101, MaineCare Benefits Manual, Section 12, Chapter III, Allowances for Consumer Directed Attendant Services, and Chapter 101, MaineCare Benefits Manual, Section 96, Chapter III, Private Duty Nursing and Personal Care Services. The rates will be amended to reflect 100% of the final rates modeled in the February 1, 2016 report Rate Review for Personal Care and Related Services: Final Rate Models prepared by Burns & Associates, Inc. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an aggregate increase of $3,969,529 in SFY 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: August 7, 2018 Posted: July 31, 2018
 
MaineCare Benefits Manual Chapter III, Sections 19, 21, and 29 WORD  PDF   
Concise Summary: SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 19, Chapter III, Home and Community Benefits for the Elderly and Adults with Disabilities; Chapter 101, MaineCare Benefits Manual, Section 21, Chapter III, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder; and Chapter 101, MaineCare Benefits Manual, Section 29, Chapter III, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder; NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services to amend the rates of reimbursement for personal care and related services under Chapter 101, MaineCare Benefits Manual, Section 19, Chapter III, Home and Community Benefits for the Elderly and Adults with Disabilities. The rates will be amended to reflect 100% of the final rates modeled in the February 1, 2016 report Rate Review for Personal Care and Related Services: Final Rate Models prepared by Burns & Associates, Inc. Also, the Department plans to request approval from the Centers for Medicare and Medicaid Services to amend the rates of reimbursement for services provided to adult MaineCare members with intellectual disabilities or autism under a waiver granted by the federal Centers for Medicare and Medicaid Services for home-based and community-based care on the basis of rates and a methodology established by Department rulemaking. The Chapter 101, MaineCare Benefits Manual, Section 21, Chapter III, Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder amended procedure codes are:
  • T2017 home support;
  • T2017 SC home support with medical add-on;
  • T2017 GT home support - remote support;
  • T2016 agency home support;
  • T2016 agency home support over 168 hours;
  • T2016 SC agency home support with medical add-on;
  • S5140 shared living foster care, adult, one member;
  • S5140 TG shared living foster care, adult, one member, increased level of support;
  • S5140 UN shared living foster care, adult, 2 members;
  • S5140 UN TG shared living foster care, adult, 2 members, increased level of support;
  • T2021 community support;
  • T2021 SC community support with medical add-on;
  • T2015 career planning;
  • T2019 employment specialist services;
  • T2019 SC employment specialist services with medical add-on;
  • H2023 work support, individual;
  • H2023 SC work support with medical add-on;
  • H2023 UN work support, group, 2 members;
  • H2023 UP work support, group, 3 members;
  • H2023 UQ work support, group, 4 members;
  • H2023 UR work support, group, 5 members;
  • H2023 US work support, group, 6 members;
  • T2034 crisis intervention services;
  • T2016 U5 home support, family-centered support, one member;
  • T2016 TG U5 home support, family-centered support, one member, increased level of support;
  • T2016 UN U5 home support, family-centered support, 2 members;
  • T2016 UN TG U5 home support, family-centered support, 2 members, increased level of support;
  • T2016 UP U5 home support, family-centered support, 3 members;
  • T2016 UP TG U5 home support, family-centered support, 3 members, increased level of support;
  • T2016 UQ U5 home support, family-centered support, 4 members;
  • T2016 UQ TG U5 home support, family-centered support, 4 members, increased level of support;
  • T2016 UR U5 home support, family-centered support, 5 or more members; and
  • T2016 UR TG U5 home support, family-centered support, 5 or more members, increased level of support.
Furthermore, the Chapter 101, MaineCare Benefits Manual, Section 29, Chapter III, Allowances for Support Services for Adults with Intellectual Disabilities or Autistic Disorder amended procedure codes are:
  • T2017 home support, 1/4 hour;
  • T2017 GT home support, remote support;
  • T2021 community support;
  • T2021 SC community support with medical add-on;
  • T2019 employment specialist services;
  • T2019 SC employment specialist services with medical add-on;
  • H2023 work support, individual;
  • H2023 SC work support - supported employment with medical add-on;
  • H2023 UN work support, group, 2 members;
  • H2023 UP work support, group, 3 members;
  • H2023 UQ work support, group, 4 members;
  • H2023 UR work support, group, 5 members;
  • H2023 US work support, group, 6 members;
  • T2015 career planning;
  • S5150 respite, 1/4 hour;
  • S5151 respite, per diem;
  • S5140 shared living foster care, adult, one member; and
  • S5140 UN shared living foster care, adult, 2 members.
REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2017, ch. 459, An Act Making Certain Supplemental Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an aggregate increase of $81,217,539 in SFY 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See https://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: August 7, 2018 Posted: July 31, 2018
 
MaineCare Accountable Communities Program WORD  PDF   
Concise Summary: The Department of Health and Human Services (DHHS) will request approval from the Centers for Medicare and Medicaid Services to make changes to MaineCare‚€™s Accountable Communities (AC) program, for performance years beginning August 1, 2018. The proposed changes include the following methodology changes, beginning in performance year five: ‚€Ę Under the new quality scoring proposal, ACs can receive ‚€œachievement points‚€ and ‚€œimprovement points‚€ dependent on their performance on a given quality measure. ACs may receive up to a maximum of two achievement points on each quality measure within each domain, and have the potential to receive supplemental improvement points. Maximum possible points within each domain is equal to the number of achievement points possible within each domain. Total improvement points that contribute to an AC‚€™s quality score in a domain cannot exceed a quarter of the total point value possible through achievement points. Point values are totaled at the domain level and then domain level scores are weighted to generate an AC‚€™s overall score. o Achievement. An ‚€œattainment threshold‚€ and ‚€œexcellence benchmark‚€ will be established for each measure, set at the 25th and 90th percentiles, respectively, of Maine non-AC practices, when available. An AC will receive zero achievement points if its performance score is less than the attainment threshold, two achievement points if its performance score meets or exceeds the attainment threshold, and if its performance score is between the attainment threshold and the excellence benchmark. Achievement points are determined by the following formula: 2*((performance score- attainment threshold)/(excellence benchmark- attainment threshold)). o Improvement. An AC will receive zero improvement points if they do not have a performance score for the quality measure in the previous performance year. An AC will receive zero improvement points if it does not improve the gap between its previous year‚€™s score and the excellence benchmark by 10%. An AC will receive one improvement point if it improves the gap between its previous year‚€™s score and the excellence benchmark by 10%. ‚€Ę Update the base year used in the Total Cost Of Care (TCOC) analysis to August 1, 2016 ‚€“ July 31, 2017; ‚€Ę Update the claims cap used in the TCOC analysis based on more current data. The claims caps adjustment is used to minimize variations from one year to the next due to AC members with large claims. The proposal is that total annual claims for any individual member in excess of the following claims caps not be included in TCOC: Attributed Members in AC Lead Entity Claims Cap 1,000 ‚€“ 1,999 $50,000 2,000 ‚€“ 4,999 $155,000 5,000+ $210,000 REASON FOR PROPOSED CHANGES: These changes are being made to ensure the quality measurement aspect of the program is relevant and reflective of Department goals and to ensure the TCOC analysis is using appropriate data. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: There is not expected to be any increase or decrease in annual expenditure due to these changes specifically. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Olivia Alford AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4059 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing)
Submit Comments (Opens in new window) Comment Deadline: September 11, 2018 Posted: July 30, 2018
 
MaineCare Benefits Manual, Chapters II & III, Section 107, Psychiatric Residential Treatment Facilities WORD  PDF   
Concise Summary: The Department plans to request approval from the Centers for Medicare and Medicaid Services for the addition of a new covered service for Psychiatric Residential Treatment Facilities (PRTF). The request addresses the PRTFs’ covered services, policies and procedures, standards, and reimbursement methodology. This service is intended to address a current gap in Maine’s offering of behavioral health services to youth under the age of 21. The PRTF is being created to specifically address a high need to support Maine’s most vulnerable youth, including: youth in out of state placement, youth stranded in psychiatric hospitalization with no safe discharge option, youth stranded in emergency rooms with no safe placement, and incarcerated youth in need of mental health treatment. PRTFs are federally regulated facilities by the Centers for Medicare and Medicaid Services (CMS) via 42 C.F.R. 441 Subpart D and 42 C.F.R.483 Subpart G. PRTFs will be reimbursed for direct services from qualified practitioners and include a cost-settled component for allowable costs. REASON FOR PROPOSED CHANGES: This rulemaking intends to create a new section of policy describing Psychiatric Residential Treatment Facilities, pursuant to 42 C.F.R. 441 Subpart D and 42 C.F.R.483 Subpart G. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that the costs of this rulemaking are unable to be determined at this time due to the complexity of the rule and inability to accurately determine how many members will seek to access PRTF programs from incarceration, hospitalization, and out of state placement. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Thomas M. Leet Thomas.Leet@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4068 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: June 24, 2018 Posted: June 14, 2018
 
MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services NATURE OF PROPOSED CHANGES: The Department plans to decrease the supplemental pool payments for Non-Critical Access hospitals, Rehabilitation Hospitals, and hospitals classified to a wage area outside of Maine by the Medicare Geographic Classification Review Board (as defined in MBM, Section 45). The Department also plans to increase the Rehabilitation Hospital per discharge rate. The total pool shall equal $71,380,072. Up to $60,000,000 will be allocated to outpatient services, and up to $60,000,000 will be allocated to inpatient services, not to exceed the total supplemental pool amount and not to exceed allowable aggregate upper payment limits. The Medicaid per discharge reimbursement rate provided to rehabilitation hospitals is increasing from $12,440.44 to $15,161.43. REASON FOR PROPOSED CHANGES: All changes are pursuant to P.L. 2018, ch. 41, Resolve, Regarding Medicaid Reimbursement for Rehabilitation Hospitals. ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral in Federal Fiscal Years 2018 and 2019. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.Cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: June 5, 2018 Posted: May 29, 2018
 
MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment WORD  PDF   
Concise Summary: AGENCY: Department of Health and Human Services, Office of MaineCare Services AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 60, Chapter II, Medical Supplies and Durable Medical Equipment (DME) NATURE OF PROPOSED CHANGES: The Department plans to request approval from the Centers for Medicare and Medicaid Services for the following changes to Medical Supplies and Durable Medical Equipment (DME) reimbursement: • Updates reimbursement for certain DME items to align with current Medicare rural rates: o Items impacted are those which are required to be in alignment per the scope of the 21st Century Cures Act. • Institutes reimbursement methodology for specially modified low protein foods for members with inborn errors of metabolism. • Further defines reimbursement methodology for items that are not Medicare covered or are Medicare covered but not impacted by the 21st Century Cures Act. REASON FOR PROPOSED CHANGES: To comply with 42 C.F.R ß440.70 and 42 U.S. C. ß1396b ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: This rulemaking is estimated to save $411,053 in SFY 2018, which includes $146,581 in state dollars. ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Cook Kristin.cook@maine.gov AGENCY NAME: Office of MaineCare Services ADDRESS: 242 State Street, 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207) 624-4006 FAX: (207) 287-1864 TTY: 711 Maine Relay (Deaf or Hard of Hearing) See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
Submit Comments (Opens in new window) Comment Deadline: June 5, 2018 Posted: May 29, 2018
 
MaineCare Benefits Manual, Section 92, Chapters II and III, Behavioral Health Home (BHH) Services WORD  PDF   
Concise Summary: The Department plans to request approval from the Centers for Medicare and Medicaid Services related to Section 92, Behavioral Health Homes reimbursement. Other changes encompassed surround Pay-for-Performance and minimum billable activities. Please see the attachment for a full description. Please submit any comments or concerns related to these changes via the “Submit Comments” function below, or by contacting Kristin Cook by email at Kristin.cook@maine.gov; by phone at (207) 624-4006 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: April 11, 2018 Posted: April 3, 2018
 
MaineCare Benefits Manual, Section 25, Dental Services WORD  PDF   
Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to amend coverage of Section 25 dental services by including reimbursement for the procedure codes included in the attached document. Please see the attachment for a full description. Please submit any comments or concerns related to these changes via the “Submit Comments” function below, or by contacting Tom Leet by email at Thomas.leet@maine.gov; by phone at (207) 624-4068 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: January 8, 2018 Posted: December 28, 2017
 
MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services (Appendices C and F) WORD  PDF   
Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to allow Appendix C and Appendix F, Private Non-Medical Institutions to request an adjustment to a prospective rate and/or a temporary supplemental payment for certain costs related to regulation compliance and/or extraordinary circumstances. Please submit any comments or concerns related to these changes via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: October 26, 2017 Posted: October 19, 2017
 
MaineCare Benefits Manual, Section 45, Chapters II and II, Hospital Services WORD  PDF   
Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to make a number of reimbursement and administrative changes to Section 45, Hospital Services. Please see the attached document for a full description. Please submit any comments or concerns related to these changes via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: October 13, 2017 Posted: October 3, 2017
 
MaineCare Benefits Manual, Section 96 Private Duty Nursing and Personal Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to increase the monthly costs caps for Section 96, Private Duty Nursing and Personal Care Services to account for recent reimbursement increases for certain Section 96 services. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: October 10, 2017 Posted: October 2, 2017
 
MaineCare Benefits Manual, Section 12, CDA Services and Section 96, PDN and PCS WORD  PDF   
Concise Summary: Concise summary: In accordance with P.L. 2017 Ch. 284 Sec. MMMMMMM-1, the Department plans to request approval from the Centers for Medicare and Medicaid Services to increase reimbursement for certain personal care and related services under Section 12, Consumer Directed Attendant Services and Section 96, Private Duty Nursing and Personal Care Services. As part of these changes, the Department will implement the corresponding recommendation from the rate study referenced in the budget to change billing of the PCA Supervisit from a 15-minute/unit service to a “per visit” service. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: September 8, 2017 Posted: September 5, 2017
 
MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services WORD  PDF   
Concise Summary: This SPA aligns the MaineCare Benefits Manual, Section 80, Pharmacy Services with the CMS Covered Outpatient Drug Final Rule (CMS-2345-FC), provides updated reimbursement methodologies, increases the professional dispensing fee for most medications to $11.89, and clarifies existing pharmacy coverage parameters. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: August 23, 2017 Posted: August 15, 2017
 
MaineCare Benefits Manual, Section 45, Chapter III, Hospital Services WORD  PDF   
Concise Summary: The Department plans to submit a State Plan Amendment to increase the supplemental pool dollar amount for Non-Critical Access hospitals, hospitals classified to a wage area outside of Maine by the Medicare Geographic Classification Review Board, and Rehabilitation hospitals in accordance with P.L. 2017 Ch. 284 Sec. ZZZZZZ-9. The Department also seeks to amend the supplemental pool allocation methodology to ensure that the annual supplemental payments do not exceed the allowable upper payment. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: August 5, 2017 Posted: July 26, 2017
 
MaineCare Benefits Manual, Chapter II, Section 75, Vision Services WORD  PDF   
Concise Summary: The Department will submit a State Plan Amendment (SPA) to add 65778, Placement of amniotic membrane on the ocular surface; without sutures, (reimbursed at $629.73) to the Vision Services section of the State Plan. This SPA will also add the existing reimbursement methodology for MaineCare Benefits Manual, Chapter II, Section 75, Vision Services, into the State Plan. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or by mail at 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: July 9, 2017 Posted: June 29, 2017
 
MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services, Appendix C; Section 2, Adult Family Care Services WORD  PDF   
Concise Summary: This State Plan Amendment seeks to implement a three and a half (3.5) percent cost-of-living rate increase for Section 2, Adult Family Care Services and Section 97, Appendix C, Private Non-Medical Institution Services for fiscal year ending June 30, 2018. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: June 30, 2017 Posted: June 28, 2017
 
MaineCare Benefits Manual, Section 93, Opioid Health Home Services WORD  PDF   
Concise Summary: The Department plans to request approval from the Centers for Medicare and Medicaid Services to implement an Opioid Health Home (OHH) for members with opioid dependency who are receiving Medication-Assisted Treatment (MAT) in the form of buprenorphine, buprenorphine derivatives, and/or naltrexone. OHH care management/care coordination (“health home”) services will be reimbursed at $394.40 per member per month. However, the OHH providers will receive this as part of a bundled rate. Eligible OHH providers must bundle a monthly office visit with the MAT prescriber and counseling related to opioid dependency. The OHH provider may bundle in the reimbursement of the buprenorphine, buprenorphine derivatives, and/or naltrexone medications. The full bundled rate will be $1,000 per member per month. The rate without the medications is $496.00. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: April 10, 2017 Posted: April 5, 2017
 
MaineCare Benefits Manual, Section 25, Dental Services WORD  PDF   
Concise Summary: The Department will request approval to add the following dental procedures codes at the given rates: D1575 ($95.00); D3221 ($88.00), D4346 ($40.00), D9248 ($98.50). Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email at Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: February 26, 2017 Posted: February 16, 2017
 
MaineCare Benefits Manual, Section 96, Private Duty Nursing and Personal Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (DHHS) previously requested approval from the Centers for Medicare and Medicaid Services to increase reimbursement for personal care and related services, pursuant to Public Law 2016, Chapter 83 Resolves. Through the corresponding rulemaking process, the Department determined another code in MBM, Section 96, should see a rate increase. This code is T1019 0589, and the rate will be increased to $4.62. The correction of this clerical error is consistent with the rate for the same service under Procedure Code T1019 that was set forth in the rule proposal, and is a benefit to both providers and members. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: January 13, 2017 Posted: January 9, 2017
 
MaineCare Benefits Manual, Section 68, Occupational Therapy Services and Section 85, Physical Therapy Services WORD  PDF   
Concise Summary: Effective January 1, 2017, the Current Procedural Terminology coding manual Occupational Therapy codes 97003 and 97004 are being eliminated and replaced with codes 97165, 97166, 97167, and 97168. Effective the same date, the Current Procedural Terminology Physical Therapy coding manual codes 97001, 97002, are being eliminated and replaced with codes 97161, 97162, 97163, and 97164. Please see attachment for proposed rates. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: January 2, 2017 Posted: December 22, 2016
 
MaineCare Benefits Manual, Chapter III, Section 5, Ambulance Services WORD  PDF   
Concise Summary: The Department will request approval to institute the following reimbursement rates for Ambulance Services. Medicare-covered codes will be reimbursed at 65% of the current published Maine Medicare area ‘99’ rates, except for the following services which will continue to be reimbursed at current levels: A0430, A0431, A0434, A0436 . Non-Medicare covered ambulance services will continue to be reimbursed based on the current fee schedule. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine County. To find out where the Maine DHHS offices are, call 1-800-452-1926. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: December 30, 2016 Posted: December 15, 2016
 
MaineCare Benefits Manual, Section 109, Speech and Hearing Services (UPDATED NOTICE) WORD  PDF   
Concise Summary: This entry contains an updated fiscal impact estimate for the addition of the following code to the State Plan: 92586: Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited (see below).
Submit Comments (Opens in new window) Comment Deadline: December 9, 2016 Posted: December 8, 2016
 
MaineCare Benefits Manual, Section 109, Speech and Hearing Services WORD  PDF   
Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to add the following procedure code to the Speech and Hearing Services’ fee schedule in the State Plan: 92586: Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited. Agency Rate: $37.14 per session, Independent Rate $26.82 per session. The additional code allows providers to bill for limited audiometry and/or testing of the central nervous system; comprehensive audiometry and/or testing is already a covered service. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333.
Submit Comments (Opens in new window) Comment Deadline: December 9, 2016 Posted: December 6, 2016
 
MaineCare Benefits Manual, Section 95, Podiatric Services WORD  PDF   
Concise Summary: The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to describe the reimbursement methodology for Podiatric Service. The following language does not reflect a change in reimbursement: The fee schedule reimburses at the lowest of the following for covered services: 1) The lowest amount allowed by Medicare Part B for Maine area “99” fee, 2) 47.70% of the 2005 Medicare Part B for Maine area “99” fee or 47.70% of the rate in the first year that Medicare assigned a rate for the code, or 3) Where no other options are applicable, the Department will research other State Medicaid agencies that cover the relevant service/code and base its rates on the average cost of the relevant services/codes from those other agencies. If the provider’s usual and customary charge for a service is lower than the fee schedule rate, the provider’s usual and customary charge will be reimbursed. In addition, the following code will be added to Section 95, Podiatric Services: 97762, Checkout for orthotic/prosthetic use, established patient, each 15 minutes. Reimbursement will be $11.48 for non-facilities, and $7.79 facilities. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333. Comments are due by 11:59 PM on Monday, September 19, 2016.
Submit Comments (Opens in new window) Comment Deadline: September 19, 2016 Posted: September 8, 2016
 
CLARIFICATION TO POSTING BELOW: MaineCare Benefits Manual Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services      
Concise Summary: The comment deadline for MaineCare Benefits Manual Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services is 11:59 p.m. Tuesday, September 13th.
Submit Comments (Opens in new window) Comment Deadline: September 13, 2016 Posted: September 8, 2016
 
MaineCare Benefits Manual Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services WORD  PDF   
Concise Summary: The Department of Health and Human Services (DHHS) will request approval from the Centers for Medicare and Medicaid Services to increase reimbursement for personal care and related services, pursuant to Public Law 2016, Chapter 83 Resolves. Please see the attachment for how rates in MaineCare Benefits Manual, Section 12, Consumer Direct Attendant Services and Section 96, Private Duty Nursing and Personal Care Services will be restructured. To avoid a reduction in services available to members receiving services under Section 96, Private Duty Nursing and Personal Care Services, DHHS will increase the applicable monthly cost caps to account only for the increase in reimbursement. The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location. Please submit any comments or concerns related to this change via the “Submit Comments” function below, or by contacting Olivia Alford by email Olivia.alford@maine.gov, phone (207)-624-4059 or TTY: 711 Maine Relay (Deaf or Hard of Hearing), Fax (207) 287-1864, or mail 242 State St., SHS#11, Augusta, ME 04333. Comments are due by 11:59 PM on Tuesday, September 6, 2016. Note: This methodology notice was originally published in state newspapers on July 28, 2016.
Submit Comments (Opens in new window) Comment Deadline: September 13, 2016 Posted: September 2, 2016
 

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