September 24, 2021 MaineCare Updates

Maine Department of Health & Human Services sent this bulletin at 09/24/2021 02:24 PM EDT

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In this message:

Attention: Providers of Sections 18, 20, 21 and 29: Revised Instructions and Additional Guidance to Apply for Retainer Payments
Pharmacy Point of Sale (POS) Blackout Period on October 6, 2021
Microdyn Update for Ambulatory Payment Classifications (APC), and Diagnostic Related Group (DRG), CR 103590, 103591, and 103348
Maine Pediatric & Behavioral Health Partnership Round Table Discussion
Attention Providers of Section 65, Behavioral Health Services: Adult Medication Management Services
Provider Trainings

Attention: Providers of Sections 18, 20, 21 and 29: Revised Instructions and Additional Guidance to Apply for Retainer Payments

Deadline to Submit Attestation Forms Extended Through September 30, 2021

This is a follow up to our August 30^th e-message regarding HCBS Retainer Payments for Sections 18, 20, 21, and 29.

In order to allow providers additional time to apply for retroactive retainer payments for select services, we are extending the deadline for submission of the associated attestation forms from September 17, 2021 to October 1, 2021.

With the extended deadline, we anticipate that payments will be made in early to mid- November 2021, and we will issue an e-message when we have a more specific date. Timing of the payments is in part dependent on providers’ timely submission of attestation forms.

The instructions and attestation form are available in the Home and Community-Based Services (HCBS) Retainer Payment Request Guidelines.

Please note that all other guidance, including attestations, remain as written in the original guidance.

Additional Guidance to Providers Applying for Retainer Payments

The Department offers the following additional guidance regarding the application process and attestation form:

1) Are the retainer payments meant to cover all program costs or just staffing costs?

CMS guidance refers to “revenues” and “rates for services” and does not indicate that retainer payments are to cover only staffing costs. Current rates are inclusive of program costs with staff costs as one component of those rates.

2) Do provider agencies include ALL staff when considering whether Attestation #4 regarding staff layoffs has been met?

In accordance with CMS guidance, receipt of retainer payments is “specific to the staff who would have been paid to render personal care, if not for the pandemic, closure, etc., and the service that contains personal care or component of personal care.” Given this guidance, Attestation #4 applies to those staff working in and delivering the select services as outlined on page 1 of the guidance.

3) Will providers qualify for retainer payments if they were able to hire back a percentage of staff members laid off after March 1, 2020 by September 2021?

In accordance with specific guidance and guidelines set forth by CMS, states must “Require an attestation from the provider that it will not lay off staff, and will maintain wages at existing levels.” Providers who laid off direct care staff working within the select services outlined in the original guidance after March 1, 2020 are not eligible to receive retainer payments.

4) Are Paycheck Protection Program (PPP) loans and Provider Relief Funds considered “funding from other public sources”?

Yes, PPP loans and Provider Relief Funds are considered funding from other public sources and must be included as directed in the guidance.

5) Do “revenues in excess of pre-PHE levels” apply only to revenue from the specific eligible services listed in the guidance, or also to other services that may be delivered by the agency?

Providers must report revenues received for the specified months and the specified services outlined on page 1 of the original guidance. Revenues for any other services other than those specified should not be included in the application.

6) How did Maine determine the time period for the pre-PHE level?

In accordance with CMS guidelines, states must “Require an attestation from the provider that they had not received funding from any other sources, including but not limited to unemployment benefits and Small Business Administration loans, that would exceed their revenue for the last full quarter prior to the PHE, or that the retainer payments at the level provided by the state would not result in their revenue exceeding that of the quarter prior to the PHE.” The first full quarter prior to the PHE corresponds to the comparison months set forth in the application/guidance form: October, November, and December 2019.

7) Is it allowable for provider agencies with multiple NPI+3 locations to list all the applicable NPI+3 location on one attestation form?

Yes, it is allowable for provider agencies to list multiple service delivery locations for the specified services listed in the original guidance on one attestation form.

Please contact Provider Relations Specialist Tammy Usher with questions.

Pharmacy Point of Sale (POS) Blackout Period on October 6, 2021

The POS system will be unavailable for approximately eight hours starting at 8:00 PM on Wednesday, October 6, 2021 for system maintenance. Pharmacy claims will not be adjudicated during this time.

MaineCare would like to thank all pharmacy providers for their patience during this process and we apologize for any inconvenience this may cause. Please call the POS Helpdesk with questions at 1-888-420-9711.

Microdyn Update for Ambulatory Payment Classifications (APC), and Diagnostic Related Group (DRG), CR 103590, 103591, and 103348

Effective August 28, 2021, the Centers for Medicare and Medicaid Services’ (CMS) quarterly updates have been added in MIHMS. The following CMS documents provide the details of the July 2021 APC and DRG updates:

July Integrated Outpatient Code Editor Specs:https://www.cms.gov/files/document/r10824cp.pdf
July Update of the Hospital Outpatient Prospective Payment System (OPPS): https://www.cms.gov/files/document/r10825cp.pdf
July Update for DRG: Logic update for Major Diagnostic Categories 11 (MDC). Correct assignment of DRG 674 that should be 673.

Due to the delay in processing this update, some vaccination claims did not pay at the correct rates. Claims that processed with the wrong rate will be adjusted, and no provider action is needed.

Maine Pediatric & Behavioral Health Partnership Round Table Discussion

On behalf of the Maine Pediatric & Behavioral Health Partnership Program, we would like to invite you to participate in a round table discussion happening on October 13, 2021 from 12:00-1:00 pm.

This is a time for pediatric care providers to come together with behavioral health providers and discuss the demands of managing youth and adolescent mental health needs in the primary care setting.

We will give an overview of the Maine Pediatric & Behavioral Health Partnership program, what services we provide, and how we can partner with more pediatric care providers. This is also an opportunity for you to share needs and barriers concerning behavioral health in the pediatric care setting.

We hope that you will be able to take some time to participate in this round table discussion to share your valuable insight.

Please register in advance for this event so we know who will be joining us!

You can learn more about Maine Pediatric & Behavioral Health Partnership and our services at www.BHpartnersforME.org.

Please contact Stacey Laflamme with any questions.

Attention Providers of Section 65, Behavioral Health Services: Adult Medication Management Services

Kepro, in collaboration with the Office of Behavioral Health (OBH), has streamlined the process for Department Medication Management Referrals.

Beginning October 18, 2021, the Department will submit Medication Management Referrals to providers via Kepro’s Atrezzo portal. Receiving providers will need to confirm acceptance of the referral or submit a request to refuse the referral, via the Atrezzo portal. Receiving providers who accept a referral or receive a denial from OBH to refuse a referral, will need to submit an authorization request upon the client’s admission to the service.

Kepro will is offering a provider training on Tuesday, October 12, 2021, from 11:00 am to 12:00 PM. Please register for this optional training. If you are unable to attend the training, materials will be available on our website www.qualitycareforme.com/resources/training/

For questions, please contact Kepro Provider Relations at (866)-521-0027, Option 3 or via email at ProviderRelationsME@kepro.com

Provider Trainings

The Office of MaineCare Services is hosting virtual provider trainings about multiple sections of MaineCare policy. Each session will include information regarding provider enrollment and MaineCare policy. The trainings will be held via Zoom and registration is required for each session. Please be advised, the registration link will be emailed directly to you on the morning of the scheduled training. Please be sure to key in your correct email address when registering.

You can register online, and the Zoom link will be provided after registration.

Training Schedule

All trainings are scheduled from 9:00 – 11:00 am unless noted otherwise below.

Section 45, All Maine Hospitals: September 28, 2021
Section 50, ICF-MR Services: September 30, 2021
Sections 21 & 29, Home/Community Benefits for Members w/Intellectual Disabilities or Autistic Disorder and Support Services for Adults w/ Intellectual Disabilities or Autistic Disorder: October 5, 2021
Section 55, Laboratory Services: October 7, 2021
Sections 18 & 20, Home/Comm Based Services for Adults w/ Brain Injury and Home/Comm Benefits for Adults w/ Other Related Conditions: October 12, 2021
Sections 14 & 90, Advanced Practice Registered Nursing Services and Physician Services: October 14, 2021
Sections 40 & 43, Home Health Services and Hospice Services: October 19, 2021
Section 97-Appendix B, Principles of Reimbursement for Substance Abuse Treatment Facilities: October 21, 2021
Section 97-Appendix C & F, Principles of Reimbursement for Medical and Remedial Service Facilities and Principles of Reimbursement for Non-Case Mixed Medical and Remedial Facilities: October 26, 2021
Section 5, Ambulance Services: October 28, 2021
Section 2, Adult Family Care Services: November 2, 2021
Section 68, 85, & 109, Occupational Therapy Services, Physical Therapy Services, and Speech and Hearing Services: November 4, 2021
Section 25, Dental Services: November 9, 2021
Section 67, Nursing Facility Services: November 16, 2021
Section 31 & 103, FQHC and RHC: November 18, 2021
Section 102, Rehabilitative Services: November 30, 2021
Section 15 Chiropractic Services: December 2, 2021 FROM 9:00 to 10:00
Section 75, Vision Services: December 2, 2021 FROM 10:00 to 11:00
Section 9, Indian Health Services: December 7, 2021
Section 19 & 96, Home/Comm Based Benefits for the Elderly and/or Adults w/ Disabilities and Private Duty Nursing and Personal Care Services: December 9, 2021
Section 30, Family Planning Agency Services: December 14, 2021

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