MaineCare’s Comprehensive Rate System Evaluation: Phase 1 Stakeholder Engagement
Maine Department of Health & Human Services sent this bulletin at 09/25/2020 02:32 PM EDT
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MaineCare’s Comprehensive Rate System Evaluation: Phase 1 Stakeholder Engagement
September 25, 2020
This is a follow up to our previous message regarding MaineCare’s Comprehensive Rate System Evaluation and the stakeholder engagement plans for Phase 1 of this initiative. As previously communicated, Phase 1 includes gathering input through a series of meetings with MaineCare providers and provider representatives regarding the impact that MaineCare’s current reimbursement methodologies have on providers, services, and MaineCare members.
These meetings will not involve discussion of actual reimbursement rate amounts, but instead will serve to provide us with an understanding of how the current MaineCare payment methodologies work and the effects they have on service delivery. Stakeholders will have an opportunity to provide input regarding rate amounts during Phase 2, when we will be gathering feedback on the Phase 1 benchmark report and on the adequacy of rates and access to services in general.
To the extent possible, we have grouped these virtual meetings by providers who deliver similar services and/or are reimbursed under similar methodologies. The schedule of meetings can be found below.
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Monday, October 5, 2020 |
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9:00-12:00 |
Miscellaneous Services Sec. 101: Medical Imaging Services Sec. 25: Dental Services Sec. 5: Ambulance Services Sec. 55: Laboratory Services Sec. 60: Medical Supplies and Durable Medical Equipment |
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1:00-4:00 |
Physician, APRN, and Primary Care Services Sec. 103: Rural Health Clinic Services Sec. 14: Advanced Practice Registered Nursing Services Sec. 31: Federally Qualified Health Center Services Sec. 90: Physician Services Sec. 91: Health Home Services Sec. 94: Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) |
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Tuesday, October 6, 2020 |
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10:00-1:00 |
Behavioral Health Services - Community Sec. 13: Targeted Case Management Services Sec. 17: Community Support Services - Assertive Community Treatment Sec. 17: Community Support Services - Community Integration Services Sec. 17: Community Support Services - Community Rehabilitation Services Sec. 17: Community Support Services - Daily Living Support Services Sec. 28: Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations Sec. 65: Behavioral Health Services- ACT Sec. 65: Behavioral Health Services- Behavioral Health Day Treatment Sec. 65: Behavioral Health Services- Clubhouse Sec. 65: Behavioral Health Services- Crisis Sec. 65: Behavioral Health Services- Home and Community Based Treatment (HCBT) Sec. 92: Behavioral Health Home Services Sec. 93: Opioid Health Home Services Sec. 97: Private Non-Medical Institution Services, App D Therapeutic Foster Care only |
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2:00-5:00 |
Behavioral Health Services – Outpatient Sec. 17: Community Support Services - Day Supports Services Sec. 17: Community Support Services - Interpreter Services Sec. 17: Community Support Services - Skills Development Services Sec. 65: Behavioral Health Services- Behavioral Therapy Sec. 65: Behavioral Health Services- Intensive Outpatient Program (IOP) Sec. 65: Behavioral Health Services- Medication Assisted Treatment (MAT) Sec. 65: Behavioral Health Services- Medication Management Sec. 65: Behavioral Health Services- Neurobehavioral Sec. 65: Behavioral Health Services- Outpatient |
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Wednesday, October 7, 2020 |
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8:00-11:00 |
Home and Community-Based Services for Older Adults and Members with Physical Disabilities Sec. 12: Consumer Directed Attendant Services Sec. 19: Home and Community Benefits for the Elderly and Adults with Disabilities Sec. 26: Day Health Services Sec. 40: Home Health Services Sec. 43: Hospice Services Sec. 96: Private Duty Nursing and Personal Care Services |
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1:00-4:00 |
Home and Community-Based Services for Members with Intellectual or Developmental Disabilities and/or Acquired Brain Injury and Other Related Conditions Sec. 102: Rehabilitative Services Sec. 18: Home and Community-Based Services for Adults with Brain Injury Sec. 20: Home and Community Based Services for Adults with Other Related Conditions Sec. 21: Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder Sec. 23: Developmental and Behavioral Clinic Services Sec. 29: Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Sec. 50: Intermediate Care Facilities for Individuals with Intellectual Disabilities Services |
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Thursday, October 8, 2020 |
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12:00-3:00 |
Hospital Services Sec. 45, Hospital Services Sec. 46, Psychiatric Hospital Services |
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3:00-6:00 |
Specialty Services Sec. 109: Speech and Hearing Services Sec. 15: Chiropractic Services Sec. 68: Occupational Therapy Services Sec. 75: Vision Services Sec. 85: Physical Therapy Services Sec. 95: Podiatric Services |
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Friday, October 9, 2020 |
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8:00-11:00 |
Residential Care Sec. 107: Psychiatric Residential Treatment Facility Services Sec. 2: Adult Family Care Services Sec. 97: Private Non-Medical Institution Services- App B, D, E (excluding App D Therapeutic Foster Care) Sec. 97: Private Non-Medical Institution Services- App C Sec. 97: Private Non-Medical Institution Services- App F |
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12:00-3:00 |
Nursing Facilities Sec. 67, Nursing Facility Services |
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3:00-6:00 |
Ambulatory Care/ Clinics Sec. 3: Ambulatory Care Clinic Services Sec. 30: Family Planning Agency Services Sec. 4: Ambulatory Surgical Center Services Sec. 7: Free-standing Dialysis Services |
Prior to attending their meeting(s), we are asking providers to review our discussion questions that will be used to guide the conversations. More information, including how to register for these meetings, will be forthcoming in the near future. In the meantime, providers may send an email to RateSettingEval@maine.gov with any questions.
Input gathered during these meetings will supplement other Phase 1 efforts which will result in a report that catalogs existing payment methods; benchmarks payment rates to those used by other Medicaid states, commercial health plans, and Medicare for comparable services; and recommends services as candidates for alternative payment models (APMs).
Providers and other interested parties who would like to submit comments in writing may do so at any time by sending an email to RateSettingEval@maine.gov.