Rule Proposal: Chapters II & III, Section 40, Home Health Services
Maine Department of Health & Human Services sent this bulletin at 09/26/2018 10:06 AM EDT
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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 a notices of Agency Major Substantive Rule-making Proposal. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml
Notice of Agency Major Substantive Rule-making Proposal
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapters II & III, Section 40, Home Health Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY: Chapter III, Section 40, Home Health Services increases some reimbursement rates for Home Health Services pursuant to Resolve 2017, ch. 61, To Support Home Health Services, effective January 1, 2019.
Additional Chapter III changes include:
- Procedure codes, as set forth by the Centers for Medicare and Medicaid Services (CMS), effective retroactive to January 1, 2016, are updated. The procedure code for the services of a skilled nurse (RN) is updated to G0299 from G0154 TD. The procedure code for a skilled nurse (LPN/LVN) is updated to G0300 from G0154 TE. Procedure codes G1054 TD and G1054 TE are eliminated through this rulemaking as they are obsolete.
- Procedure code S9110 GT, for telemonitoring of a patient in their home, is added to Chapter III to support the reimbursement for this new covered service as proposed in Chapter II, Section 40, Home Health Services. This service is currently described in the MaineCare Benefits Manual, Chapter 1, Section 4, Telehealth Services, but has been added to this Section for clarity. This procedure code is effective retroactive to April 16, 2016.
- This Chapter III proposed rule seeks to increase the following rates effective 1/1/19: G0299, G0300, G0156, G0152, G0152 TF, G0151, G0151 TF, G0153, G0153 TF, and G0155.
Chapter II changes include:
- Pursuant to 42 CFR § 440.70, Home Health Services eligibility criteria is updated to read any home health service may be offered as the sole home health service and shall not be contingent upon the provision of another home health service.
- Other Eligibility for Care changes: Medical Eligibility Requirements for Interactive Telehealth Services and Telemonitoring Services.
- New definitions added: Health Care Provider, Interactive Telehealth Services, Telehealth Services, and Telemonitoring Services, Authorized Agent is changed to Authorized Entity And updated throughout the policy.
- Additions to Covered Services: Interactive Telehealth Services and Telemonitoring Services.
- Pursuant to Section 12006, 21st Century CURES Act, Electronic Visit Verification (EVV) requirements for home health services providers, as of January 1, 2023, are added.
- Non-Routine Medical Supplies includes an updated link to billing instructions and list of supplies.
- Throughout the policy, “mental retardation” has been updated to “individuals with intellectual disabilities” and “severe and disabling mental illness” has been updated to “Severe and Persistent Mental Illness” to align with Section 17, Community Support Services.
- A typographical error in the header of Chapter II, which read “Chapter III”, has been corrected.
- Limitations have been updated to reflect that members of Section 19, Home and Community Based Services for Elders and Adults with Disabilities, may be receive authorization for nursing services through Section 40, Home Health Services, should Section 19 nursing services be deemed insufficient to meet the member’s needs.
- MaineCare Services, Division of Customer Service has been updated to MaineCare Provider Services with an updated toll-free number.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173, 7863; 5 M.R.S. §§ 8054, 8072; Resolve 2017, ch. 61, 42 CFR § 440.70
PUBLIC HEARING:
Date: October 15, 2018
Time: 1:00 p.m.
Location: Cross Office Building
Conference Room 400 (This is a fragrance-free environment)
111 Sewall Street
Augusta, ME 04330
The Department requests that any interested party requiring special arrangements to attend the hearing contact the agency person listed below before October 9, 2018.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 p.m. on October 25, 2018.
AGENCY CONTACT PERSON: Heidi Bechard, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 242 State Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-4074 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that these rulemakings will not have any impact on municipalities or counties. There may be additional costs to small business for compliance with the EVV requirements, however compliance with those federal requirements is not required until January 1, 2023.