State-funded Abortion Services
Maine Department of Health & Human Services sent this bulletin at 09/19/2019 03:35 PM EDT
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State-funded Abortion Services
Effective September 19, 2019, MaineCare will begin covering abortion services as per Public Law, Chapter 274, An Act to Prevent Discrimination in Public and Private Insurance Coverage for Pregnant Women in Maine, which requires DHHS to use state funds to cover abortion services that are not eligible for reimbursement from the Centers for Medicare and Medicaid Services (CMS).
To receive reimbursement for these state-funded abortion services and state-funded abortion-related services, providers must add the SE modifier on the outpatient UB04 and CMS 1500 claims they submit to MaineCare. This modifier must be added to every line of the claim. Any unrelated services can be submitted on a separate claim without the SE modifier if the separate claim meets standard billing guidelines. Inpatient UB04 claims should be submitted with the AH condition code.
Claims with the SE modifier on all claim lines (or an AH condition code on the claim header for inpatient only) and an abortion diagnosis code will be paid using state funds. During the initial implementation period, these claims will be paid within 30 days. Once required systems changes are in place, these claims will be processed after one day.
Claims without the modifier code (those for Medicaid-covered abortions) on all claim lines and with an abortion diagnosis code will pend for 30 days and then will be reviewed for proper paperwork as directed in the Provider Instructions/Form for MaineCare Covered Abortion Services before being released for payment. Claims without proper paperwork will be denied. This is the same process that currently exists for Medicaid-covered abortions.
Required Agreement
Providers that wish to provide state-funded abortion services must download and sign the Provider Agreement for State-Funded Health Programs and must receive a fully executed agreement from MaineCare before claims for these services can be processed. Without this state-funded agreement, services will not be reimbursed. Providers will need to sign and submit this agreement to tia.l.bolduc@maine.gov. Providers who submit a claim for state-funded abortion services without having a signed agreement will be contacted and given 30 days to sign and submit.
The state-funded abortion rule can be accessed at https://www.maine.gov/sos/cec/rules/10/chaps10.htm under Ch. 104, Section 7, Abortion Services for MaineCare Members.