Rule Adoption: Chapters II and III, Section 15, Chiropractic Services

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 

---

Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE:  10-144 C.M.R., Chapter 101, MaineCare Benefits Manual (MBM), Chapters II and III, Section 15, Chiropractic Services

ADOPTED RULE NUMBER:

CONCISE SUMMARY: 

The Department of Health and Human Services (“the Department”) is adopting this rule to add coverage of evaluation and management examinations performed by chiropractors, pursuant to Public Law 2017, ch. 421, An Act To Provide MaineCare Coverage for Chiropractic Treatment.

P.L. 2017, ch 421 requires the Department under the MaineCare program to reimburse chiropractic evaluation and management examinations performed by a chiropractic doctor licensed under Title 32, Maine Revised Statutes, chapter 9, that are within the scope of practice of chiropractic doctors. The Legislature authorized the Department to adopt routine technical rules to implement P.L. 2017, ch. 421. MaineCare reimbursement for chiropractic services is regulated by 10-144 C.M.R. ch. 101, MaineCare Benefits Manual (MBM), Chapters II and III, Section 15, Chiropractic Services. 

In Chapter II, the Department added coverage for evaluations or re-evaluations of spinal conditions to determine the rehabilitative effectiveness of chiropractic manipulation by chiropractors as a covered service under Subsection 15.04(A). Eligibility for chiropractic services may be determined by members’ primary care providers or a chiropractor, as set forth in Subsection 15.03(B). Additionally, the Department changed the term “subluxation” to “spinal conditions” throughout the rule to align with Medicaid requirements. In Subsection 15.05, the Department clarified that X-rays ordered or performed by or for a chiropractor that are not of the spine are non-covered services. Finally, the Department directed chiropractors to use evaluation and management codes 99201-99215 for the purposes of examining and diagnosing a spinal condition, in Subsection 15.07-1(A).  

In Chapter III, the Department identified evaluation and management codes 99201-99215 to be used for evaluations and management purposes. Additionally, the rule states that the rates for these codes are shown on the Physician Fee Schedule under MaineCare Usual and Customary Rates and a link was inserted to the Physician Fee Schedule for reimbursement purposes. Finally, the Department is adopting minor technical edits.

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

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

EFFECTIVE DATE:                         April 12, 2019

AGENCY CONTACT PERSON:    Cari Philbrick, Comprehensive Health Planner II

AGENCY NAME:                             Division of Policy

ADDRESS:                                        242 State Street, 11 State House Station

            Augusta, Maine 04333-0011

                                                            Email: Cari.Philbrick@maine.gov

TELEPHONE:                                  (207) 624-4031 FAX: (207) 287-1864

                        TTY users call Maine relay 711