MaineCare Policy and State Plan Amendments E-Message - November 13, 2015
Maine Department of Health & Human Services sent this bulletin at 11/13/2015 10:41 AM ESTHaving trouble viewing this email? View it as a Web page.
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Below, please find two Notices of Agency Rule-making Proposals. You can access the complete rules at http://www.maine.gov/dhhs/oms/rules/index.shtml
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144, Chapter 101, MaineCare Benefits Manual, Chapter I, Section 1, General Administrative Policies and Procedures
PROPOSED RULE NUMBER:
CONCISE SUMMARY: The Department of Health and Human Services (DHHS) is proposing to remove the Telehealth section from Chapter 101, MaineCare Benefits Manual, Chapter I, Section 1, General Administrative Policies and Procedures concurrent with the implementation of Chapter 101, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
PUBLIC HEARING:
Date: December 7, 2015
Time: 9:00 AM
Location: Room 300, Burton Cross Building, 111 Sewall Street, Augusta, ME 04330
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before November 30, 2015.
DEADLINE FOR COMMENTS: Comments must be received by midnight December 17, 2015.
AGENCY CONTACT PERSON: Thomas Leet, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St.
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4068 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services, MaineCare Services
RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY Current MaineCare policy in Chapter 1, Section 1.06-2, allows a limited group of providers to provide services remotely to patients through the use of telehealth, which is defined as “the use of electronic communication by a health care provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment.” Under the current telehealth rule, for each instance where telehealth is used, a provider is required to submit documentation showing that a physical, social or geographic limitation exists that prevents the provider from delivering a MaineCare covered service to a particular member in a face-to-face encounter, or to otherwise justify the use of telehealth as more appropriate, and to get the Department’s prior authorization before using telehealth services.
MaineCare staff and MaineCare providers have found the current telehealth policy to be too restrictive. Providers have found it difficult to obtain approval for telehealth in some cases, and staff has found it challenging to implement a consistent system of review.
In response to these challenges, the Legislature passed LD 1596 in 2014. This LD directed the Department to “convene a working group to review the MaineCare rules regarding the definition of telehealth and the technologies used for provider patient interaction involving MaineCare patients” and to make according changes to MaineCare policy.
MaineCare staff convened a workgroup consisting of providers, industry stakeholders, advocates, and lawmakers. The group met several times over late spring and summer 2014, and a draft policy was written based on the feedback provided by the group and upon extensive research conducted by MaineCare staff. The drafted policy combined stakeholder recommendations with industry best practices. A working draft of the policy was submitted to the stakeholder group for comments in fall 2014, and the comments were compiled in written form and responded to by MaineCare staff.
The proposed new telehealth policy is written as a standalone policy, as opposed to a subsection of Chapter I, Section 1, as it was previously. The new rule will be effective upon the repeal of the current telehealth rule (Ch. I Sec. 1.06-2). The major components of the new telehealth rule are as follows:
- Removes the prior approval process for use of telehealth;
- Allows telehealth for all medically necessary services that can be delivered remotely at comparable quality;
- Provides for an “originating site fee” to be paid to the site housing the patient, while the remote, or provider site, bills for the services rendered;
- Provides for visual/audio, or, if video/audio is not available, the provision of telephonic services;
- Requires providers to use secure, HIPAA compliant equipment; and;
- Requires member choice, written informed consent, and member education.
In addition to Interactive Telehealth Services, the policy also provides for a new service known as “Telemonitoring.” Telemonitoring provides electronic communication between a member and healthcare provider whereby health-related data is collected, such as pulse and blood pressure readings that assist healthcare providers in monitoring and assessing the member’s medical conditions. Telemonitoring takes place in the home environment. Home Health agencies deliver Telemonitoring Services. In order to be eligible, a member must have had two or more hospitalizations or emergency department visits related to their diagnosis in the past calendar year, or have continuously received telemonitoring services during the past calendar year and have a continuing need for such services, as documented by an annual note from a licensed healthcare provider.
See http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html for rules and related rulemaking documents.
THIS RULE WILL NOT HAVE A FISCAL IMPACT ON MUNICIPALITIES.
STATUTORY AUTHORITY: 22 M.R.S.A. §§ 42, 3173; LD 1596, Ch. 105, Resolve, Directing the Department of Health and Human Services To Amend MaineCare Rules as They Pertain to the Delivery of Covered Services via Telecommunications Technology
PUBLIC HEARING:
Date and Time: December 7, 2015 10 AM
Location: Room 300
Burton Cross Building
111 Sewall Street, Augusta, Maine 04330
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before November 30, 2015.
DEADLINE FOR COMMENTS: Comments must be received by midnight December 17, 2015.
AGENCY CONTACT PERSON: Samuel Senft, Comprehensive Health Planner
AGENCY NAME: MaineCare Services
ADDRESS: 242 State Street
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4053 FAX: (207) 287-1864 TTY: 711