Ch. I, Section 1, General Administrative Policies and Procedures Rule-Making Proposal - March 7, 2017
Maine Department of Health & Human Services sent this bulletin at 02/07/2017 09:31 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 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: Chapter 101, MaineCare Benefits Manual, Chapter I, Section 1, General Administrative Policies and Procedures
PROPOSED RULE NUMBER:
CONCISE SUMMARY: This rule adds a new provision for the exclusion or termination of certain providers who would be excluded under current state and federal law. The rule also updates the provider reinstatement procedures. The rule proposes to add language describing the requirement for providers to pay an enrollment fee for each provider site. The rule also adds language that the Department may deny future rental of equipment to members who fail to return Department rented equipment. The rule adds language that authorizes the Department to request additional information which demonstrates a provider applicant’s ability to provide high-quality care, services, and supplies and to be financially responsible. The rule also adds language that the liability for debts owed to the Department by providers is also enforceable against people and entities with ownership or controlling interest and specifically defines those individuals and entities. The rule also adds tobacco cessation products and services to the list of copayment exemptions. The rule adds language that authorizes providers to refuse to continue to see members who have repeatedly broken appointments. The rule adds language describing NCCI edits and a statement that MaineCare will reject nonconforming claims. The rule also adds clarifying language around out-of-state providers.
The Department proposes to add three new grounds for sanctions to include:
- An entity that is an HMO or is providing services under a Medicaid waiver program, and has a substantial contractual relationship with an entity that could be excluded from the Medicaid program;
- If a provider has been convicted of a crime while performing services as a health care worker or provider; and
- Limitation of services for which the provider is authorized to perform and receive payment.
In addition, the rule proposes to clarify the role of the Medicaid Advisory Committee. The rule also removes Private Non-Medical Institutions (PNMIs) from the list of facilities that include interpreter services in their reimbursement calculations and language regarding Section 113 of the MaineCare Benefits Manual. The rule also adds language that the Department will not reimburse for interpreter travel time. The rule includes language adding an exception of LCDs or NCDs denials to provider requirement of third party denial appeal process. The rule also proposes to modify the language describing the Department’s liability for the Medicare deductible and coinsurance by addition of specific language directly related to various facilities and eligibility situations and payment or nonpayment of deductible and coinsurance. The rule proposes to remove language stating that the Department will enroll all providers who meet certain requirements, and replacement with a new provision, which sets forth a list of factors the Department may consider in determining whether to enroll or deny enrollment to a provider applicant.
The Department proposes to amend and add definitions to the policy. The rule proposes to make technical, grammar, and punctuation edits as well. Lastly, the Department proposes to make changes to conform with state and federal laws.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; 5 M.R.S. § 4551 et seq; 22 M.R.S. § 42(8); 42 C.F.R. 1007; P.L. 2014, Ch. 444 (An Act to Reduce Tobacco-related Illness and Lower Health Care Costs in MaineCare) (to be codified at 22 M.R.S. § 3174-WW); 42 U.S.C. § 1320a–7; 42 C.F.R. 431.55(h)(2); 42 C.F.R. 455.416(c)l; Patient Protection and Affordable Care Act, Public Law 111–148; Rosa's Law, Public Law 111-256; L.D. 1596 (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); 22 M.R.S. § 3173-C, sub-§2, as amended by P.L. 2011, Ch. 458 (An Act Regarding Pharmacy Reimbursement in MaineCare).
PUBLIC HEARING:
Date: Tuesday, February 28, 2017
Time: 9:30 a.m.
Place: Marquardt Building
32 Blossom Lane, 1st floor, Room 118
Augusta, ME 04333
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed before February 18, 2017.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on Friday, March 10, 2017.
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.