Section 65 Update: Medication Assisted Treatment with Methadone - Attention Referring Providers: Changes to KEPRO’s Referral Management Process for Home and Community Treatment and Rehabilitative Community Services

Section 65 Update: Medication Assisted Treatment with Methadone

The Office of MaineCare Services would like to provide an update regarding the Medication Assisted Treatment with Methadone (MAT) reimbursement rate in Section 65, Behavioral Health Services.

Pursuant to P.L. 2019, Ch. 343, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds, and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2019, June 30, 2020 and June 30, 2021, (effective June 17, 2019), the Legislature increased funding for the weekly reimbursement rate for MAT services for the FY2020 and FY2021 state budgets.

This change effectively increases the rate of reimbursement from $81.60 per week to $110.00 per week for MAT services reimbursed through Section 65. While rulemaking is forthcoming, the Department has amended its billing system to allow providers to seek reimbursement at the increased rate effective immediately. This reimbursement increase is retroactive to July 1, 2019. Affected claims will be reprocessed and no provider action is needed.

For any questions regarding this notice, please contact your Provider Relations Specialist, Rebecca Maranda, by email at Rebecca.A.Maranda@maine.gov or by phone at (207) 624-6963.

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Attention Referring Providers: Changes to KEPRO’s Referral Management Process for Home and Community Treatment and Rehabilitative Community Services

The Office of Children and Family Services (OCFS), in coordination with KEPRO, has implemented changes in the referral management process, effective immediately. In an effort to improve the referral process for both Home and Community Treatment and Rehabilitative Community Services, OCFS has added family members’ availability times to the referral questionnaire.

The following are changes to the Referral Management Questionnaire:

Reporting Times

Waitlist changes on a daily basis. Time of report will be point in time with the goal of matching more efficiently for families and providers.

Provider Referral Matches

We will match a child in need of services with a provider closest to child’s home.

Family Availability

Based on the date of the initial referral, family availability reported may vary. The questionnaire will provide current availability at time as it may have changed since the initial referral.

Risk Factors

Corrections involvement and expulsion from daycare/head start has also been added to the referral questionnaire. 

Capacity

Capacity is when a provider has staffing to serve a child for Section 65 HCT or Section 28 RCS.

1. Capacity should be reported every time you have staff available to serve a family.

A. A report of capacity means you have staff available to fully serve the child.

B. Capacity should be reported via KEPRO Maine Intake at IntakeME@kepro.com

C. You do not need to call KEPRO to request a preferred provider referral. The referral for the preferred provider child will be sent to the individual provider in Atrezzo. For questions on how to access this information on an authorization report, please contact KEPRO provider relations at ProviderRelationsME@kepro.com

2. If your staff only has availability during a certain time, please note it when you report capacity.

3. You will be matched to the longest waiting child or priority need in the area, even if a specific town is identified.

4. The public version of the waitlist is a one-time per week report. The waitlist changes on a daily basis.

5. If there is a clinical need identified, please include it when reporting capacity. For example: BHP is a younger male and should not be matched with a teenage female. 

For KEPRO related questions, please reach out to IntakeME@kepro.com. For OCFS related questions, please reach out to your local OCFS Resource Coordinator.