Attention: Providers of Sections 18, 19, 20, 21 and 29 - Attention Behavioral Health Professionals: Survey about Tobacco Use - Common Adjustment Reason Codes (CARC) & Remittance Advice Remark Codes (RARC) Update

Maine Department of Health & Human Services sent this bulletin at 08/21/2020 11:03 AM EDT

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Attention: Providers of Sections 18, 19, 20, 21 and 29 

Certain Service Caps and Related Provisions in Appendix K Amendment Extended Through October 31, 2020 

 

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 was originally set to expire on May 31, 2020, but due to continuing need, the Department extended this provision until August 31, 2020. At this time, based on the need to continue assigning staff in a manner that promotes infection prevention and control, and the ongoing need of some participants for temporary service provisions, the Department finds a continuing need to extend Section K-2.b.ii. through October 31, 2020.    

 

Extended provisions include, but are 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 October based on continuing need at that time.  

 

Appendix K, Section K-2.b.ii Provisions Extended Through October 31, 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   
  • 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.   

 

Attention Behavioral Health Professionals: Survey about Tobacco Use 

In partnership with the MaineHealth Center for Tobacco Independence (Maine QuitLink and Breathe Easy Maine), the Maine CDC and the Office of Behavioral Health are exploring ways to address the toll of tobacco use on people with behavioral health conditions.

We are asking behavioral health professionals to complete a survey by August 31, 2020, to help us:

  • Better understand what tobacco assessment, treatment practices, and policies are in place at behavioral health organizations.
  • Learn what treatment measures are effective for the populations with which you work.
  • Determine next steps to implement and sustain tobacco use prevention and treatment strategies in behavioral health settings. 

We have two surveys; one for organizational leadership and one for direct service providers. 

Click on the link that best corresponds with your role in your agency. The link will take you to the survey, which takes about 20 minutes to complete. 

Leadership Survey: https://www.surveymonkey.com/r/BHTobacco_LeadershipVersion

The organizational leadership survey provides an opportunity to recommend three staff to be survey participants. This will allow us to get an even broader reach of information.

Direct Service Provider Survey: https://www.surveymonkey.com/r/BHTobacco_DirectServicesStaffVersion

Thank you for your time and thoughtful responses on this important issue. 

Please contact Selina.McGlauflin@maine.gov with questions.

Common Adjustment Reason Codes (CARC) & Remittance Advice Remark Codes (RARC) Update

The CARC & RARC reference document has been updated and is available on the MIHMS Health PAS Online Portal. The document includes information on common PEND reasons in MIHMS. You can also view pended claims and reasons on the portal. You can access the CARC & RARC document by going to the Supplemental Billing folder on the Health PAS Online Portal.