July 2, 2021 MaineCare Updates

Attention PNMI Appendix C Facilities: Update to Rates for State Fiscal Years 2020 and 2021

This is a follow up  to our December 22, 2020 e-message that informed Appendix C providers of revisions to inflation factors used in rates for State Fiscal Years 2020 and 2021, which resulted in a downward adjustment to rates. 

After considering feedback from providers and the impact of the COVID-19 Public Health Emergency, the Department has decided to revise some of those inflationary factors back to the original factors, resulting in a partial upward adjustment to rates for both years. 

There are two categories of changes being made:

• A projected 5.7% inflation amount was used for the period 1/1/19 – 6/30/20 in the original rate letters. This inflation adjustment was intended to be “trued up” to equal actual inflation, if necessary, at the end of the year. The December 2020 communication and reissuance of the SFY21 rate letter reflected this true-up to actual 4.0% inflation. Due to the impact of COVID-19, the Department has decided to leave the higher 5.7% inflation in place for FY20 and FY21 rate letters. 

• The other inflation adjustments referenced in the December 2020 e-message were necessary in order to correct historical errors the Department discovered. These downward adjustments will remain in place, as the Department has an obligation to correct all errors and would be at audit risk if it did not do so.

Five revised rate letters (covering the periods listed below) will be posted at the portal no later than the end of July; another message will be sent at that point to inform you that the letters are available.

1. 7/1/19 – 12/31/19
2. 1/1/20 – 6/30/20
3. 3/1/20 – 5/31/20 (temporary COVID-related ECA rates)
4. 7/1/20 – 12/31/20
5. 1/1/21 – 6/30/21 

Facilities may choose to rebill any services that are within the one year window from the date of service; any unadjusted claims will be handled at settlement.

Rate letters for the current period 7/1/21 – 12/31/21 will be posted at the portal no later than early August.  Please note that the inflation factor for the period 1/1/19 – 6/30/20 will revert to 4.0% (from 5.7%) in these forthcoming FY22 rate letters and rate letters for all future periods.

 

MaineCare Benefit Manual, Ch. II, Sections 30, 31, 45, and 103: JG Modifier Denials, CR 102626

We have corrected an issue where some claims submitted with JG Modifier denied in error.  The issue impacted claims submitted from April 1, 2021 through June 23, 2021. Claims that denied in error will be reprocessed and no provider action is needed. Please contact your Provider Relations Specialist with questions. 

 

Rate update for Section 2 Adult Family Care Home and AFCH Remote Island, CR 102900

Effective July 1, 2021, Section 2 Adult Family Care Home rates will be increased by 2.9 percent for fiscal year (FY) 2022.

Per Chapter III, Section 2, of the MaineCare Benefits Manual, which states that “Effective July 1, 2019, payment rates attributable to wages and salaries for personal care and related services will be increased annually by an inflation adjustment cost-of-living percentage in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index, Medical Care Services index from the prior December for professional services, nursing home and adult day care services. Those cost of living increases shall continue annually until the Department has completed a rate study for adult family care services”  

The new rates are in the table below and can also be found on the Health PAS Online portal. 

Resource Group	MaineCare Weight	Resource Adjusted Price (based on $58.50 Unadjusted Price multiplied by MaineCare Weight)	Start Date	End Date
1	1.657	$96.94	7/1/2021	6/30/2022
2	1.210	$70.79	7/1/2021	6/30/2022
3	1.360	$79.56	7/1/2021	6/30/2022
4	1.027	$60.08	7/1/2021	6/30/2022
5	0.924	$54.05	7/1/2021	6/30/2022
6	0.804	$47.03	7/1/2021	6/30/2022
7	0.551	$32.23	7/1/2021	6/30/2022
8	0.551	$32.23	7/1/2021	6/30/2022

 

Remote Island:

Resource Group	MaineCare Weight	Resource Adjusted Price (based on $67.28 Unadjusted Price multiplied by MaineCare Weight)	Start Date	End Date
1	1.657	$111.48	7/1/2021	6/30/2022
2	1.210	$81.41	7/1/2021	6/30/2022
3	1.360	$91.50	7/1/2021	6/30/2022
4	1.027	$69.10	7/1/2021	6/30/2022
5	0.924	$62.17	7/1/2021	6/30/2022
6	0.804	$54.09	7/1/2021	6/30/2022
7	0.551	$37.07	7/1/2021	6/30/2022
8	0.551	$37.07	7/1/2021	6/30/2022

 

If you have questions about the rates please contact Rate Setting directly by emailing either Dwayne.A.Parsons@maine.gov or Grace.Williams@maine.gov.

 

Rate update for Section 26 Day Health Services, CR 102899

Effective July 1, 2021, the rate for Section 26 Day Health Services (S5100 HC – Day Care Services) will be increased by 2.9% from $3.75 to $3.86 for Fiscal Year (FY) 2022.

Per Chapter III, Section 26, of the MaineCare Benefits Manual, which states that “Effective July 1, 2019, payment rates attributable to wages and salaries for personal care and related services will be increased annually by an inflation adjustment cost-of-living percentage in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index, Medical care services (professional services, nursing home and adult day care services) from the prior December.  These cost of living increases shall continue annually until the Department has completed a rate study for adult family care services, adult day services or homemaker services and the rates in the rate study have been implemented.”

The new rate can also be viewed on the Health PAS Online Portal.

If you have questions about the rate, please contact Rate Setting directly by emailing either Dwayne.A.Parsons@maine.gov or Grace.Williams@maine.gov.

 

COVID-19 Vaccine Update for Section 80, Pharmacy Services

As we previously announced, effective March 11, 2021, under the American Rescue Plan Act (ARPA), uninsured individuals are eligible to receive coverage for COVID-19 vaccine administration and treatment at no cost to the individual. This message is to inform providers that we can now accept Section 80, Pharmacy Services, claims for COVID-19 vaccine administration for individuals in the uninsured coverage group (these individuals are identified in the system as MaineRx members).

 

This coverage is for individuals who meet the following criteria: 

 

They are a Maine resident; 

• They are a U.S. citizen, U.S. national, or eligible immigrant; and
• They are uninsured;
  • Not eligible for or enrolled in MaineCare or Cub Care;
  • Not enrolled in another health care program funded by the federal government, including: Medicare, TRICARE, and Veterans Administration, and federal employee health plans; and
  • Not enrolled in a commercial group health plan or other health insurance coverage.

Providers who had been holding their claims for covered COVID-19 vaccine administration codes for dates of service on or after March 11, 2021 may now submit their claims. Providers may also resubmit any previously denied claims for covered COVID-19 vaccine administration codes for dates of service on or after March 11, 2021.  

MaineCare is reimbursing providers based on Medicare’s regional rates for Maine, per our standard practice. The reimbursement rate will be set at 100% of the regional rate. More information about the vaccine administration and product rates can be found in our COVID-19 Vaccination Coverage Guidance.  

Please note that MaineCare will not reimburse providers for services when providers are being reimbursed through a separate arrangement with another payer, such as the Health Resources and Services Administration (HRSA). 

For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-888-420-9711 or via email to PBA_helpdesk@changehealthcare.com.

For more information on COVID-19 billing, please see MaineCare’s COVID-19 Billing and Coding Guidance. 

For more information on testing, treatment, and vaccination coverage for uninsured individuals, please see MaineCare’s provider guidance on this topic.

Upcoming Provider Training Sessions

The Office of MaineCare Services, in coordination with Kepro, is hosting virtual provider trainings about multiple sections of MaineCare policy. Each session will include information regarding provider enrollment, MaineCare policy, and submitting authorization requests. The trainings will be held via Zoom and registration is required for each session. You can register online, and the Zoom link will be provided after registration.

Training Schedule

• Section 13, Targeted Case Management: July 22 (Children) and July 29 (Adult)
• Section 17, Community Support Services: July 13 and July 20
• Section 28, Community-Based: August 10 and August 12
• School-Based Services, Sections 28 and 65: August 17 and August 19
• Section 46, SHH and Acadia only: September 14
• Section 65, Behavioral Health Services: August 24 and August 26
• Section 92, Behavioral Health Homes: August 3 and August 5
• Section 93, Opioid Health Homes: September 16
• Section 97, Appendix D and Treatment Foster Care: August 31 and September 2
• Section 97, Adult PNMI only: September 9

 For questions about the registration process, please contact Tia Bolduc. For general training questions, please contact Kepro provider relations.