Attention Dental Providers - Attention: Providers of Sections 18, 19, 20, 21 and 29: Certain Service Caps and Related Provisions in Appendix K Amendment Extended Through June 30 - COVID-19 Updates 

Maine Department of Health & Human Services sent this bulletin at 05/29/2020 04:23 PM EDT

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Attention Dental Providers 

 

This is a follow up from our May 27, 2020 e-message about new dental codes to include the rates for these new codes.  

Service/Code 

Rate 

D0190 – Patient Screening 

$14.42 

D0191 – Patient Assessment 

$14.55 

 

For more information on all dental rates, please refer to our dental services fee schedule.  

Please see the language from our original message below: 

Telehealth and Dental Services  

  

Effective March 1, 2020, the following codes will be added as MaineCare-covered services in order to enable payment to dental providers for triage and screening services performed via telehealth:  

  

  • D0190 – Patient Screening. This is a screening, including state or federally mandated screenings, to determine an individual’s need to be seen by a dentist for diagnosis.   

  

  • D0191 – Patient Assessment. This is a limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.  

  

These codes can be billed on their own, or with the following two codes that will be added effective March 1, 2020. The following codes are used to indicate that the other service on the claim was performed via telehealth. Per guidance from the State of Maine Board of Dental Practice, MaineCare providers should only use these codes in conjunction with codes related to triage and screening.  

  

  • D9995 tele-dentistry – Synchronous; real-time encounter. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.   

  

  • D9996 tele-dentistry – Asynchronous; information stored and forwarded to dentist for subsequent review. 

Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.   

D9995 and D9996 should not be billed on their own as they are used to indicate how the services were delivered and will always pay at zero. The codes should be appended to a claim that includes the triage and/or screening codes to note the modality of service (telehealth). Providers should submit a claim with the reimbursable triage or screening code on one service line and then the D9995/D9996 on the other service line to designate the service was performed via telehealth. Please see the updated ADA guidance for more information on these D-codes.    

  

Providers may also provide triage and screening services through use of D9995/D9996 in conjunction with existing codes D0140 limited oral evaluation – problem focused; D0170 re-evaluation – limited, problem focused (established patient; not post-operative visit); or D0171 re-evaluation – post-operative office visit.  

  

Please see the following scenarios as examples of when a provider must also indicate the D9995 or D9996 codes to indicate the triage and screening related services were performed via telehealth.  

  

  • Scenario 1: Patient contact with dentist who provides the consultation using audio only.   
  • Coding: D0190 (screening)   

  

  • Scenario 2: Patient contact with dentist who provides the problem-focused evaluation using audio/visual.  
  • Coding: D0140 or D0170 or D0171   

  

Please remember that all providers are still required to bill in accordance with the guidance and regulations outlined by the State of Maine Board of Dental Practice.   

 

Attention: Providers of Sections 18, 19, 20, 21 and 29: Certain Service Caps and Related Provisions in Appendix K Amendment Extended Through June 30  

Appendix K to Maine’s Home- and Community-Based Services waiver programs provides flexibility to operate waiver programs during an emergency.   

Section K-2.b.ii. of Appendix K expires on May 31, 2020, but the Department may extend the provision if there is a continuing need. Based on the number of COVID-19 positive cases among HCBS participants and staff, the Department finds a continuing need to extend Section K-2.b.ii. through June 30, 2020.   

The provisions in Section K-2.b.ii. continue to be subject to prior approval. This includes, but is not limited to the following flexibilities:  

  • Budget allocations may be exceeded to address emergency needs; 
  • Certain service caps may be exceeded to address emergency needs. These vary by waiver. Please read the provisions below carefully; 
  • Recognizing that staff shortages persist, staffing levels may fall below authorized levels provided that agencies can ensure members’ health and safety; and 
  • Data transmission charges may be allowed up to $200 per person per month to accommodate greater access to telehealth services.  

Further extensions of Section K-2.b.ii. will be considered in late June based on continuing need at that time. 

Appendix K, Section K-2.b.ii Provisions Extended Through June 30, 2020 

Appendix C-4:  

The budget allocations enumerated in Appendix C-4 of the Home- and Community-Based Services for Members Brain Injury (ME 1082), the Elderly and for Adults with Disabilities (ME 0276), the Home and Community Based Services for Adults with Other Related Conditions (ME 0995), the Home and Community Based Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (ME 0159), and the Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (ME0467) waivers may be temporarily exceeded to provide needed services for emergency care provision.   

Service Limits in Sections C-1/C-3  

ME.0276.R05.03 (Section 19) 

  • Increase the limit of available hours within Personal Care Services by up to 20 percent per week.  
  • Increase the limit for the provision of care coordination by up to 20 percent per month  
  • Increase the limit on Assistive Technology Device and Services to $6,000 and $200 per month for Assistive Technology- Transmission with prior authorization, and remove these services from the monthly program cap.  
  • Increase the limit on Respite Services by up to 20 percent per week.  
  • Increase the limit on Home Delivered Meals from one meal/day to two meals/day and remove the total cost from the monthly cap of combined Personal Care, Attendant Care, Respite, Assistive Technology and Living Well/Matter of Balance services.  
  • Remove budget allocation limits and individual caps on service to accommodate these temporary service increases.   

ME.1082.R01.02 (Section 18), ME.0995.R01.01 (Section 20), ME.0159.R06.04 (Section 21), and ME.0467.R02.04 (Section 29)  

  • Increase the service limits to Quarter Hour Home Supports to up to 64 units per day  
  • Allow up to three members to receive Shared Living in one setting for ME.0159.R06.04 (Section 21) and ME.0467.R02.04 (Section 29).  
  • For Per Diem Home Support, an agency may deliver less direct support than authorized and continue to receive the approved reimbursement rate. An agency will not be subject to minimum staffing requirements if the agency determines that it may provide for members’ health and safety with fewer staff and maintains staffing of at least 50 percent of authorized levels.  
  • Increase the limit on Assistive Technology Transmission to $200 per month for data transmission with prior authorization and remove Assistive Technology Transmission from the overall cap for 1082.R01.02 and ME.0995.R01.01.  
  • Modify limitations on Respite Services for ME.0467.R02.04.  
  • Modify limits on Care Coordination units for ME.1082.R01.02 and ME.0995.R01.01.  

COVID-19 Updates 

The following documents are now available on MaineCare’s COVID-19 webpage. 

Check the webpage often for updates.