Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual
NATURE OF PROPOSED CHANGES: The Department plans to indefinitely continue the following provisions after the end of the Federal Public Health Emergency:
- Qualification of Advanced Practice Providers to order and recertify a Plan of Care under Section 40, Home Health Services.
- Qualification of Advanced Practice Providers to order, authorize, and re-authorize a member’s Plan of Care under Section 96, Private Duty Nursing and Personal Care Services.
- Qualification of Direct Support Professionals (DSPs) to provide Crisis Services under Section 65, Behavioral Health Services.
- Reimbursement for teledentistry services and telephonic evaluation services.
- Acceptance of verbal consent in lieu of signatures for services where it is not expressly required in Maine Statue or regulation.
- Allowance of 30 days to submit certifications, recertifications, and Plans of Care for Section 40, Home Health Services.
- Retention of any rate and cap increases approved under Disaster SPA authority, with the exception of temporary add-on payments associated with facility outbreak status.
- Coverage of COVID-19 testing, treatment, and vaccine services under the Maine Medicaid State Plan.
The Department plans to temporarily continue the following provisions upon the end of the Federal Public Health Emergency:
- Reimbursement for COVID-19 Vaccine Administration equal to 100% of the Medicare Maine area 99 rate.
- Reimbursement for COVID-19 testing services equal to 70% of the Medicare Maine Jurisdiction K rate, or National Medicare rate if no Jurisdiction K rate is available.
- Waiver of copayments for the following Sections of the MaineCare Benefits Manual , through September 30, 2024:
- Section 40, Home Health Services
- Section 45, Hospital Services
- Section 55, Laboratory Services
- Section 60, Medical Supplies and Durable Medical Equipment
- Section 80, Pharmacy Services
- Section 90, Physician Services
- Section 101, Medical Imaging Services
- Section 103, Rural Health Clinic Services
- Waiver of cost sharing as required under the American Rescue Plan Act of 2021, through September 30, 2024, for:
- COVID-19 testing
- COVID-19 treatments
- COVID19 vaccines.
The Department plans to end the following provisions, effective May 12, 2023, to align with the end of the Federal Public Health Emergency:
- Coverage of the COVID-19 Uninsured population.
- Temporary outbreak rate increases to congregate care facilities: Nursing Facilities and Private Non-Medical Institutions, Appendices B, C, D, E, and F.
- Nursing Facility Quarantine Units.
- Allowance for an additional seven hospital leave days (Bed Hold days) for individuals with a confirmed diagnosis of COVID.
- Staffing allowances for MHRT-1, MHRT-C, and DSPs previously approved under Disaster SPA authority, unless otherwise specified within this notice.
- Additional time allowances for providers to complete BHP training and certification.
- Training and qualification exceptions for DSPs previously approved under Disaster SPA authority unless otherwise specified in this notice.
REASON FOR PROPOSED CHANGES: All changes are pursuant to the end of the Federal Public Health Emergency and/or the American Rescue Plan Act of 2021.
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that these changes will be cost neutral in Federal Fiscal Years 2023 and 2024.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926.
FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services