Rule-making Proposal: Ch II, Section 60, Medical Supplies and Durable Medical Equipment

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 rules at http://www.maine.gov/dhhs/oms/rules/index.shtml

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Notice of Agency Rule-making Proposal

AGENCY:  Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter II, Section 60, Title: Medical Supplies and Durable Medical Equipment

PROPOSED RULE NUMBER:

CONCISE SUMMARY:

The proposed rule provides for the following changes in Chapter II, Section 60, Medical Supplies and Durable Medical Equipment (DME):

• Updates the definition of DME to align with 42 C.F.R §440.70 (b)(3)(ii);
• Adds a storefront exclusion and reimbursement methodology for manufacturers of specialty modified low protein foods and formulas for the purpose of allowing these manufacturers to bill the Department as the supplier of prescription metabolic foods;
• Removes language implying absolute exclusions of DME items as this is no longer allowable per 42 C.F.R §440.70;
• Adds repair/replacement language for APAP and CPAP devices greater than or equal to five (5) years old.
• Removes the list of items considered MaineCare-covered for members residing within a Nursing Facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) to eliminate confusion of covered and non-covered items for members residing within a NF or ICF-IID;
• Further defines limitations for orthopedic shoes and other supportive devices for members twenty-one (21) years of age and older to provide clarity of covered services;
• Updates limits and requirements for disposable non-sterile gloves when supplied in conjunction with incontinence supplies to cost-effectively manage this covered service;
• Increases the allowance of supplies per dispense to ninety-days (90) for items MaineCare considers to be disposable DME;
• Updates reimbursement methodology for Medicare covered DME, to align with the 21^st Century Cure Act;
• Corrects and/or deletes outdated references and website addresses and,
• Edits and minor language updates for clarification purposes.

See http://www.maine.gov/dhhs/oms/rules/index.shtml  for rules and related rulemaking documents.

STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; 42 C.F.R §440.70; 42 U.S. C. §1396b

PUBLIC HEARING:

Date:                Monday, January 29, 2018

Time:               9:00 AM

Location:          Marquardt Building, Room # 118, Door D7

32 Blossom Lane, Augusta Maine 04330

The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before Monday, January 15, 2018. 

DEADLINE FOR COMMENTS:        Comments must be received by 11:59 PM on February 08, 2018

AGENCY CONTACT PERSON:        Kristin Cook, Comprehensive Health Planner I

                 Kristin.Cook@maine.gov

AGENCY NAME:                                 MaineCare Services

ADDRESS:                                            242 State Street                                                         

                11 State House Station

                Augusta, Maine  04333-0011

TELEPHONE:                                     207-624-4006 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.

CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A