August 12, 2021 MaineCare Updates

In this message:

• Private Non-Medical Institution (PMNI) Appendix D Update
• Billing Requirement for Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian Health Services (IHS), and School Health Centers Reminder 

Private Non-Medical Institution (PNMI) Appendix D Update 

The Office of MaineCare Services (OMS) has proposed changes to Chapter II, Section 97 (Private Non-Medical Institution Services) to align Maine with federal requirements to meet the Qualified Residential Treatment Program (QRTP) standards for Children’s Residential Services in Maine under the federal Family First Prevention Services Act.   

The federal deadline for meeting the QRTP requirements is October 1, 2021; however, in order to allow time for public comment, the new rules are anticipated to go into effect on November 1,, 2021. To ensure compensation is adequate for providers to meet the new requirements associated with the Family First Prevention Services Act, MaineCare will be adopting rate increases to Chapter III, Section 97 Appendix D (Child Care Facilities) in the near future.  

The rate changes in the table below are also anticipated to be effective on November 1, 2021.  These rates are the result of a rate study conducted by Burns and Associates in partnership with MaineCare, providers, and the Office of Child and Family Services (OCFS), and are revised to reflect public comments received on draft rates presented to providers on March 24, 2021. Click here for (1) details of the models used to develop the rates, and (2) responses to public comments about the draft rates. 

While OCFS does not expect providers to implement the new rules without associated rates, providers are encouraged to do the best they can to prepare for and meet QRTP standards that they are able to implement ahead of these timeframes. This may include efforts such as implementing a trauma-informed treatment model, and policies/practices related to family engagement, etc. OCFS will continue to be a resource for support and guidance as providers work toward meeting these standards. Providers should contact Christine Theriault at OCFS with questions.  

Providers are encouraged to provide comments and feedback to the Chapter II proposed rule changes via the public comment period, which is open until September 10, 2021, and may do so online.  

We sincerely thank you for the time you have contributed to assisting OCFS and OMS in preparing and planning for the implementation of the new standards for residential treatment services. This effort has been a true example of teamwork and we are grateful for your ongoing dedication and support for Maine children and families.

Billing Requirement for Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian Health Services (IHS), and School Health Centers Reminder

This is a reminder that RHC, FQHC, IHS, and School Health Center providers who bill T1015 are required to provide all encounter services related to the claim. Claims submitted with T1015 and no encounter services will be denied. The claim will also deny if all encounter services on the claim are not covered by MaineCare.  Claims that cross over automatically from Medicare will continue processing as usual. 

If you have questions, please contact your Provider Relations Specialist, Rebecca Maranda, by phone (207) 624-6963 or email at Rebecca.A.Maranda@Maine.gov.