June 25, 2021 MaineCare Updates

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End of State of Civil Emergency  

  

Earlier this month, Governor Mills announced that Maine’s State of Civil Emergency will expire on June 30, 2021. This notice is to inform providers that MaineCare’s temporary policy changes and guidance regarding our COVID-19 response will not end upon the expiration of Maine’s State of Civil Emergency. 

 

Additionally, most children and adults who currently have MaineCare coverage will continue to have that coverage through the federal Public Health Emergency. You can find more information about the Office for Family Independence’s current flexibilities associated with the federal Public Health Emergency online.

 

As previously communicated, MaineCare’s COVID-19 temporary policy changes and guidance apply for the duration of the federal Public Health Emergency (PHE), which was declared by U.S. Health and Human Services Secretary Azar. The federal PHE was renewed in April and is currently valid through July 19, 2021. In January 2021, the Acting Secretary announced that the Biden Administration would likely continue the PHE through the end of calendar year 2021, and that it would give states 60 days’ notice prior to termination. As a reminder, by law a PHE declaration can only be extended by up to 90-day increments.

  

In regard to MaineCare’s temporary policy changes related to the COVID-19 pandemic, we are working on guidance to help prepare providers for the eventual end of the federal PHE and we will keep providers updated on the status of the declaration.  

 

State Fiscal Year (SFY) 2021 Critical Access Hospital (CAH) Prospective Interim Payments (PIPs)

PIPs to CAHs are usually updated at the beginning of each state fiscal year July 1, based on the most recently filed hospital cost reports. However, due to COVID, hospitals were granted a two-month extension to file their cost reports. 

As a result: (1) the Department will not receive cost reports from hospitals with fiscal years that ended December 31, 2020 until August 2, 2021, and (2) PIPs will be updated the first week in October. 

Until then, weekly payments will continue at the SFY2020 levels, which included MaineCare Expansion adjustments for hospitals that requested such adjustments.  Once the SFY2021 PIPs are calculated, the full annual increase will be paid out over the remaining 39 weeks of SFY2021.

As was the case with SFY2020 PIPs, SFY2021 PIPs will include adjustments that may be necessary due to expansion, COVID, or other circumstances, based on analysis the Department will perform once all cost reports have been received.

If you have questions, please contact Rate Setting Manager Peter Kraut.

 

Rate Change for Section 21 Agency Home Support Providers 

The hourly rates used to calculate the per diem rates for service codes T2016 and T2016 SC (Agency Home Support) will be increasing and will impact dates of service on and after July 1, 2021. This change is occurring to comply with legislative directive PL 2021 Ch. 29, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2022 and June 30, 2023. There are no changes to other Section 21 rates.

The new hourly rates are reflected below.

 

 

Current hourly rate

Hourly rate effective 7/1/21

Regular Support Hours up to 168

$27.72

$29.28

Hours in Excess of 168

$24.80

$26.20

Medical Support Hours

$33.57

$35.53

 

Previously issued T2016/T2016 SC authorizations will soon reflect the new hourly rates for July 1, 2021 and beyond. No provider action is needed. If providers elect to submit claims before the updates occur, please follow the guidance below on how to make the appropriate adjustments later.

To Replace a claim: 

  1. Search for a claim by clicking the icon and select a claim from the Claim Status page.
  2. Select Reverse at the lower right corner of the Claim Status page.
  3. The next screen will automatically default to an adjustment option. The radio button on the left will be filled in, the middle box will be checked, and the far-right box (straight reversal) will be blank. This populates the information to Reverse this claim and create a new claim. Preserve the existing data by keeping the default setting on Use the data from this claim as basis for the new claim. The new claim will have all applicable data copied over.
  4. Select Continue and click OK when the verification question pops up. You will then get a message that the claim was successfully reversed and the R1 will populate the screen.
  5. The next screen that pops up will allow you to edit the claim information at the line level and it will display the claim number with an R1 extension at the top of the screen. Make the adjustments needed on the claim. Click Save and then Adjudicate to start processing the claim through the edits. If there are any errors, you will see them populated on the next screen. Once the claim is processed, the message will display the claim number with an A1 extension.

 

If you have authorization questions, please contact Emily Kalafarski at OADS: Emily.Kalafarski@maine.gov

If you have billing questions, please contact Tammy Usher at OMS: Tammy.L.Usher@maine.gov

 

Rate Update for Section 50 ICF-IID, CR 102907 

Effective July 1, 2021, the Fiscal Year (FY) 2022 Section 50 ICF-IID rate letters will be accessible on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.   

If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585. If you have questions about the content of the letters, please contact Rate Setting directly by using the contact name and phone number on the letters. 

 

Rate Update for Specialty Nursing Facilities (NF), CR 102902 

Effective July 1, 2021, the Fiscal Year (FY) 2022 Specialty NF rate letters will be accessible on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.   

If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585. If you have questions about the content of the letters, please contact Rate Setting directly by using the contact name and phone number on the letters. 

 

Rate update for Section 97 Appendix F, CR 102901 

Effective July 1, 2021, the Fiscal Year (FY) 2022 Section 97 Appendix F rate letters will be accessible on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.   

If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585. If you have questions about the content of the letters, please contact Rate Setting directly by using the contact name and phone number on the letters.