MaineCare Policy E-Message - February 12, 2016
Maine Department of Health & Human Services sent this bulletin at 02/12/2016 02:06 PM 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 Proposal. You can access the complete rule 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: MaineCare Benefits Manual, Chapter II, Section 90, Physician Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY:
- The rulemaking allows for unlimited coverage of comprehensive tobacco cessation treatment for all members who wish to cease the use of tobacco. These changes to Section 90 will be effective retroactive to August 1, 2014, for members eighteen (18) years of age or older or who are pregnant, in compliance with LD 386, An Act to Reduce Tobacco-related Illness and Lower Health Care Costs in MaineCare (22 MRSA §3174-WW).
- This rulemaking adds coverage for oral evaluation by a medical provider for a child under the age of three (3) who does not have a dental home and/or has not seen a dentist in the past year. This rulemaking also amends language for coverage of topical application of fluoride varnish to align with limits described in MBM, Ch. III, Section 25, Dental Services.
- The Department proposes to remove the limits of five (5) services in any consecutive seven (7) day period and eight (8) emergency therapy visits “per emergency” for no more than two (2) hours within a single twenty-four (24) hour period.
- This rulemaking removes the requirement that providers delivering psychiatric services within their scope of licensure and state law must be under direct supervision of a board eligible or certified psychiatrist. This rule also renames “Psychiatric Services,” to “Behavioral Health Services.”
- This rulemaking amends the anesthesia time unit used for billing anesthesia services to one (1) minute intervals, rather than fifteen (15) minutes, in order to comply with Health Insurance Portability and Accountability Act (HIPPA) Version 5010.
- This rulemaking clarifies (i) the limit to the number of patients that the anesthesiologist or operating physicians may supervise as a maximum of four (4) patients concurrently, (ii) the service and billing instructions for medically-directed services for physicians; and, (iii) that post-anesthesia care is a requirement of anesthesiology services.
- The time periods indicated in surgical services for post-operative treatment are amended to comply with the Centers for Medicare and Medicaid Services (“CMS”) standard fee schedule for durational global surgical periods.
- To align with the Early Periodic Screening, Diagnosis, Treatment Program (EPSDT), providers are no longer required to submit Well Child Visit (“Bright Futures”) forms in order to receive MaineCare reimbursement for services. In addition, language in this rulemaking clarifies that participation in EPSDT is optional and that providers are not required to complete a specific rider to deliver covered preventive health services.
- This rulemaking amends provider qualifications for obstetrical services to ensure that any appropriately licensed or certified, qualified professional working within their scope of licensure or certification may deliver obstetrical services to MaineCare members. Requirements around hospital admitting privileges are also amended: in order to deliver obstetrical services, providers must personally, or through a formal arrangement, have active hospital admitting privileges to an approved MaineCare hospital which includes maternity services.
- This rulemaking updates the methods by which the Department sets rates in the MaineCare Fee Schedule to include an option to obtain an average from other state Medicaid agencies for relevant codes when the code is not priced by Medicare.
- The rulemaking also increases the reimbursement of primary care physicians for certain primary care services. This initiative replaces expiring funds provided through the federal Patient Protection and Affordable Care Act (ACA), P.L. 111-148. CMS has approved a Maine State Plan Amendment for this program, effective January 1, 2015. Public Law 2015, Chapter 267 (702 – L.D. 109), Part A approved continued funding of this program, and the Section 90 policy will be updated to reflect the full initiative (an effective date of January 1, 2015). Eligible providers are those practicing with a specialty designation of Family Medicine, Internal Medicine, or Pediatric Medicine or with a subspecialty within these three primary care categories that is recognized by the American Board of Medical Specialties, the American Board of Physician Specialties, or the American Osteopathic Association. Eligibility for the increase is limited to qualified physicians and Advanced Practice Registered Nurses and Physician Assistants practicing under their direct supervision. Hospital-based physicians and physicians providing services as part of a Federally Qualified Health Center or Rural Health Clinic remain ineligible.
- This rulemaking moves specific entries under “Covered Services” that describe procedural information, including “Insurance Coverage - Insurance Benefit,” to Section 90.09-2, Reimbursement.
- This rulemaking clarifies Section 90.09-3, Reimbursement Rate for Drugs Administered By Other Than Oral Methods, without any change in coverage, reimbursement or procedures.
- This rulemaking deletes the separate Computerized Axial Tomography Scan subsection under covered services and includes the same information in 90.04-6, Medical Imaging Services.
- This rulemaking states that audiologists, physical therapists, and occupational therapists must follow the expectations and limitations in their applicable sections of policy when rendering services in a physician’s practice.
- For consistency with Section 1.03-2, which provides that MaineCare will not provide payment to any entity outside the United States, and as required by Section 6505 of the Patient Protection and Affordable Care Act, P.L. 111-148 (March 23, 2010), the following language has been removed from the policy: “or province” from multiple locations.
- This rulemaking also includes other minor and technical changes, such as updating website links, updating language to be consistent with other MaineCare materials, spelling out acronyms, updating names of government agencies, and updating titles of MBM sections.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S.A. §§ 42, 3173; 22 M.R.S. § 3174-WW; Public Law 2015, Chapter 267, Part A; Patient Protection and Affordable Care Act, P.L. 111-148, Section 6505
PUBLIC HEARING:
Date: March 7, 2016
Time: 9:00 AM
Location: Conference Room 110, Department of Health and Human Services, 19 Union Street, Augusta, Maine 04333
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before 5:00 PM, on Monday, February 29, 2016.
DEADLINE FOR COMMENTS: Comments must be received by midnight Thursday, March 17, 2016.
AGENCY CONTACT PERSON: Olivia Alford, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 242 State St
11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4059 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department does not anticipate that this rulemaking will have any impact on municipalities or counties.