Rule Adoption: Chapter 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 Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml 

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Notice of Agency Rule-making Adoption 

AGENCY:  Department of Health and Human Services, Office of MaineCare Services 

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

ADOPTED RULE NUMBER: 

CONCISE SUMMARY:  The Department is adopting changes in this rule, as set forth below. The changes include the following:

a) Updates the definition of DME to align with 42 C.F.R §440.70 (b)(3)(ii);
b) 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;
c) Removes language implying absolute exclusions of DME items as this is no longer allowable per 42 C.F.R §440.70;
d) Adds repair/replacement language for APAP, CPAP and BiPAP devices greater than or equal to five (5) years old.
e) 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;
f) 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;
g) Updates limits and requirements for disposable non-sterile gloves when supplied in conjunction with incontinence supplies to cost-effectively manage this covered service;
h) Increases the allowance of supplies per dispense to ninety-days (90) for items MaineCare considers to be disposable DME;
i) Updates reimbursement methodology to align with Medicare for Medicare covered DME impacted by the 21st Century Cures Act, and further clarify the methodology by which other rates are set, including non-Medicare covered codes, Medicare covered codes not impacted by the 21st Century Cures Act, specialty modified low protein foods and incontinence supplies;
j) Adds language surrounding guidelines, requirements and quality measures for incontinence supplies provided to MaineCare members;
k) Removes parenteral solutions from section 60.05-13, Medical Supplies and DME Not Covered for Members in an NF or ICF- IID;
l) Corrects and/or deletes outdated references and website addresses and,
m) Edits and minor language updates for clarification purposes.

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

EFFECTIVE DATE:                             June 13, 2018 

AGENCY CONTACT PERSON:        Kristin Cook, Comprehensive Health Planner

AGENCY NAME:                                 Division of Policy

ADDRESS                                              242 State Street, 11 State House Station

                                                                 Augusta, Maine 04333-0011

EMAIL:                                                  Kristin.Cook@maine.gov

TELEPHONE:                                       (207)-624-4006 FAX: (207) 287-1864

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