MAT with Methadone, Service Code H0020, No Longer on the Medicare Exempt List - Section 65 Behavioral Health Services, Intensive Outpatient Services Clarification - Drug Rates Update - Maintain Financial, Provider, and Professional Records Reminder: Keep Records for Five Years

Medication Assisted Treatment (MAT) with Methadone, Service Code H0020, No Longer on the Medicare Exempt List

Effective January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) began covering MAT programs through Medicare. Please refer to the CMS final rule and letter to opioid treatment providers for additional information. As a result of this change in coverage, MaineCare's MAT with Methadone has been removed from the Medicare exempt list and MIHMS was updated to reflect this on November 10, 2020.

Providers are now required to bill Medicare as the primary payor and MaineCare as the secondary payor when billing code H0020. H0020 claims for dual eligible Medicare members will deny without an attached Explanation of Benefits (EOB).

For providers who have previously submitted claims for dual eligible members that processed prior to billing Medicare, the Medicare payment information will not be reported on the claims. To correct payment for these members, providers must adjust the incorrectly paid claims and provide the Medicare payment information on the adjustment claim.

If you have any questions or need assistance, please contact Provider Relations Specialist, Rebecca Maranda, at Rebecca.A.Maranda@maine.gov.   

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Section 65 Behavioral Health Services, Intensive Outpatient Services Clarification 

The Office of MaineCare Services (OMS), in coordination with the Office of Child and Family Services (OCFS) and the Office of Behavioral Health (OBH), would like to clarify that Section 65.06-5, Intensive Outpatient Services (IOP) are available for youth under the age of 21 years in addition to adults.  

IOP services include the intensive and structured service of alcohol and drug assessment, diagnosis (which includes co-occurring mental health and substance abuse diagnoses), and treatment services in a non-residential setting for members who meet the American Society of Addiction Medicine (ASAM) placement criteria level II.1 or level II. Child and adult MaineCare members that meet eligibility and level of care criteria may receive IOP services under Section 65.   

Providers interested in expanding IOP access to children, may contact OCFS for consultation. Please contact Cathy Register for Region I at Cathy.Register@maine.gov, Kellie Pelletier for Region II at Kellie.Pelletier@maine.gov, or Cheryl Hathaway for Region III at Cheryl.Hathaway@maine.gov. If you expand IOP services to children, please notify MaineCare by contacting Rebecca Maranda, Provider Relations Specialist, at Rebecca.A.Maranda@maine.gov.  

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Drug Rates Update, CR 98011

Effective October 1, 2020, some rates for Chapter 1, Sections 25, 30, 45, 55, 60, 75, 90, 95, and 101 have been updated in MIHMS on November 4, 2020 and are now available for viewing on the Health PAS Online Portal.

See the spreadsheet for a list of codes with new rates which is available on the Codes & Rates webpage.

We will reprocess claims that paid at the incorrect rates from October 1, 2020 – November 4, 2020 and no provider action is needed.

Please contact your provider relations specialist with questions.

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Maintain Financial, Provider, and Professional Records Reminder: Keep Records for Five Years

All providers are required to maintain and retain contemporaneous financial, provider, and professional records sufficient to fully and accurately document the nature, scope, and details of the healthcare and/or related services or products provided to each individual MaineCare member. These records are to be kept for a period of not less than five (5) years in order to meet statutory requirements. At all reasonable times during the prescribed retention period, authorized persons from the Department of Health and Human Services or the federal government shall be given access to such records. Failure to comply with any request to examine or receive copies of such records shall be grounds for immediate suspension from participation in the MaineCare program.

Please refer to the MaineCare Benefits Manual, Chapter 1.03-8 (M) for more details about record keeping requirements. If you have any questions, please contact your provider relations specialist.