01-04-2016 MaineCare Policy E-Message
Maine Department of Health & Human Services sent this bulletin at 01/04/2016 10:24 AM EST
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 a Notice of Agency Rule-making Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: Chapter 101, MaineCare Benefits Manual, Section 55, Chapter II, Laboratory Services
ADOPTED RULE NUMBER: 2015-P149
CONCISE SUMMARY: The Department has adopted changes to this rule in order to align the language in Section 55 with the language of the Department’s State Plan Amendment (SPA). In particular, the adopted changes increase the reimbursement rate from fifty-three percent (53%) of the lowest level in the current Medicare fee schedule for Maine in effect at that time, to seventy percent (70%) of the 2009 CMS rate or seventy percent (70%) of the rate in the year CMS assigns a rate for that code. The Department will seek approval from CMS for an amendment to its SPA to reflect that the provider’s usual and customary charge is one of the several benchmarks utilized by the Department to determine reimbursement for laboratory services.
In addition, the Department has updated several provisions, including Sections 55.04-1, 55.04-2, 55.07, and 55.09, to add an updated reference to the current rates in the Maine Health PAS Portal Provider Fee Schedule and to remove outdated references such as Section 90, Chapter III, Physician Services. The Department also updated 55.02 to reflect current eligibility provisions to be consistent with other policies and current practice. It additionally updated the language in various other provisions, including Sections 55.05-3, 55.05-6, and 55.08-2, to make them consistent with current terminology. It further eliminates language referencing the diagnosis code “EMR” in Section 55.09 to align with current Medicaid billing practices. Finally, the Department removed Section 55.08-3 (Copayment Disputes), given that those requirements are set forth in Chapter I, Section 1 of the MaineCare Benefits Manual.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: Jan 2, 2016
AGENCY CONTACT PERSON: Cari Bernier, Health Planner
AGENCY NAME: Division of Policy
ADDRESS: 242 State Street
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207)-624-4031 FAX: (207) 287-9369
TTY: 711 (Deaf/Hard of Hearing)