Section 17 Assertive Community Treatment (ACT) Service Cap - Attention FQHCs and RHCs: Reimbursing Telehealth Services

Section 17 Assertive Community Treatment (ACT) Service Cap

This is a reminder that there is no longer a cap on the number of billable days for ACT services, effective November 15, 2018. 

All expectations included in the MaineCare Benefits Manual Chapter II, Section 17.04-3 apply, including ensuring that the delivery of services meets the minimum standard of a calendar monthly average of three face-to-face contacts per week. This means that on three separate days each week, the provider should see the member and provide covered services as described in policy. Providers also need to make sure that the services are primarily done in the community rather than in the office. During the COVID-19 public health emergency, telehealth may be used to satisfy the face-to-face requirements following MaineCare’s telehealth guidance.

Providers may bill for attempting to contact or locate members receiving services.  We understand that there are circumstances where an attempt to contact a MaineCare member does not result in a face-to-face meeting, but it is still expected that the calendar monthly average is met. All outreach/location attempts should be clearly documented. Providers may bill for days when a collateral contacts occurs if the monthly average face-to-face has been met. 

When submitting authorizations through Kepro, please remember that the base authorizations will continue to be at 63 units for a three-month period. Additional units may be requested using the typical continued stay review process when determined to be medically necessary and supported by clinical documentation. The request must include the clinical justification of the need for additional units. 

For any questions about this notice, please email Jane Brann, Provider Relations Specialist, or call her at (207) 624-6925. 

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Attention FQHCs and RHCs: Reimbursing Telehealth Services, CR 98696

For dates of services from January 27, 2020 through June 30, 2020, Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) telehealth distant site services will be reimbursed as part of the encounter rate when billed with HCPCS code G2025.  

For dates of services beginning on July 1, 2020, FQHC and RHC telehealth distant site services will be reimbursed at the rate of $64.42 when billed with HCPCS code G2025. Please resubmit any claims with an effective date on or after July 1, 2020 that did not pay the additional telehealth rate.

For more detail about this change, please see the Centers for Medicare and Medicaid Services’ (CMS) FQHC and RHC guidance during the Public Health Emergency (PHE). Please also refer to the following MaineCare Benefits Manual, Chapters II and III, Sections 31 and 103.

Please contact your Provider Relations Specialist with questions.