MaineCare Behavioral Health Payment Supports
Maine Department of Health & Human Services sent this bulletin at 06/26/2020 10:59 AM EDT
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MaineCare Behavioral Health Payment Supports
June 26, 2020
The Department will be offering financial support in the form of special per member per month (PMPM) payments to providers of targeted behavioral health services during the months of July and August. Certain community-based behavioral health services have been among the MaineCare-covered services hardest hit by the pandemic in terms of reduced utilization. Behavioral health organizations are often largely dependent on MaineCare revenue and serve some of our highest need members, who face serious consequences from both the pandemic and lack of access to care.
The purpose of these special payments is to:
- Compensate and incent the provider to conduct outreach to re-engage with members and resume services via telehealth or in-person.
- Compensate the provider for increased costs of delivering services under the pandemic, including costs associated with telehealth, ensuring safe social distancing practices, PPE where necessary, and staffing.
These payments are intended for providers of the subset of behavioral health services that have:
- Experienced the steepest declines in member access to care and/or volume of services provided, as demonstrated through MaineCare claims analysis.
- Are not projected to rise back up to pre-COVID utilization levels for July.
- Have not received recent, new payment support from the State.
These are services that also largely assist members with education, employment, and skills building support necessary to contribute to our state workforce and economy.
Rates have been calculated to provide targeted amounts of support proportional to the impact COVID-19 has had on service delivery and member access due to the specific needs of the member population and nature of the service being delivered.
Targeted Services and Supplemental PMPM Rates
|
Service Category |
Service |
Supplemental PMPM Rate for July & August |
|
School-Based & Children’s Behavioral Health Services |
Day Tx Behavioral Health Professional (Section 65) |
$650 |
|
Rehab & Community Supports (Section 28) |
||
|
Adult Skills, Community Support |
Clubhouse (Section 65) |
$152 |
|
School-Based Services |
Day Tx Clinician (Section 65) |
$31 |
|
Adult Skills, Community Support |
Daily Living Supports (Section 17) |
|
|
Community Integration (Section 17) |
Providers will not need to change how they submit claims to receive these increased rates and should continue billing fee for service as normal. The Department will then determine how many unduplicated members were served in a month and pay the PMPM accordingly. Information on the timing and frequency of these additional payments will be forthcoming.
Appendix B and D PNMIs – Increased Reimbursement Allowance for COVID-19 Outbreaks: Recognizing the ongoing challenges that facilities are facing related to COVID-19, the Department will provide financial support to PNMI Appendix B and D providers that experience a COVID-19 outbreak at a facility after June 1, 2020 to cover increased costs related to the outbreak.
Outbreak payment rates for Appendix Ds will be equivalent to the Temporary Rate Increases that expired on May 31, 2020. Appendix D providers should refer to the rate letters they received on April 17th regarding their temporary payment supports. Outbreak payment rates for Appendix Bs will be set at 23.9% of the facility’s regular rate.
Please note that an outbreak is defined as three or more epidemiologically-linked positive COVID cases, across staff and/or residents, in one location. The reimbursement will be available for the specific days that the facility experiences the outbreak.
More details on this provision will be forthcoming.
For more information, please contact your Provider Relations Specialist.