Date posted:
Attachment(s):
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 reduce reimbursement rates to account for repeal of the Maine Service Provider Tax (SPT) where SPT is documented in the rate methodology or model. The Department will remove all documented add-on amounts associated with the SPT for MaineCare reimbursement, effective January 1, 2025. The Department has identified the following services and sections of the MaineCare Benefits Manual where the tax is documented and where it will be removed:
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Section 17- Community Support Services |
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Procedure Code, Modifiers - Description |
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H0040 - Assertive Community Tx, per Week |
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H2012 - Behavioral Health Day Tx, per Hour |
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H2014 - Skills Training & Development, 15 Min |
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H2014, HQ - Skills Training & Development, 15 Min |
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H2015 - Community Integration, 15 Min |
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H2017 - Daily Living Supports, 15 Min |
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H2018 - Community Rehabilitation, per Diem |
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Section 28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations |
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Procedure Code, Modifiers - Description |
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H2021, TJ, HI - Home & Community, 1:1, 15 Min |
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H2021, TJ, HI, UN - Home & Community, 2:1, 15 Min |
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H2021, TJ, HI, UP - Home & Community, 3:1, 15 Min |
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H2021, TJ, HI, UQ - Home & Community, 4:1, 15 Min |
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H2021, TR, HI - School Related, 1:1, 15 Min |
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H2021, TR, HI, UN - School Related, 2:1, 15 Min |
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H2021, TR, HI, UP - School Related, 3:1, 15 Min |
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H2021, TR, HI, UQ - School Related, 4:1, 15 Min |
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H2021, U1, HK - Specialized Home & Community, 1:1, 15 Min |
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H2021, U1, HK, UN - Specialized Home & Community, 2:1, 15 Min |
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H2021, U1, HK, UP - Specialized Home & Community, 3:1, 15 Min |
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H2021, U1, HK, UQ - Specialized Home & Community, 4:1, 15 Min |
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H2021, U2, HK - Specialized School Related, 1:1, 15 Min |
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H2021, U2, HK, UN - Specialized School Related, 2:1, 15 Min |
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H2021, U2, HK, UP - Specialized School Related, 3:1, 15 Min |
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H2021, U2, HK, UQ - Specialized School Related, 4:1, 15 Min |
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G9007, HA, AF - BCBA Services (Community Based Wrap Around), 15 Min |
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Section 65 - Behavioral Health Services |
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Procedure Code, Modifiers - Description |
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H2030 - Clubhouse Services, 15 Min |
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Section 97, Appendix B – Substance Use Disorder Treatment PNMIs |
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Procedure Code, Modifiers - Description |
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H0010 - Medically Supervised Withdrawal, per Diem |
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H0010, TD - Medically Supervise Withdrawal, per Diem |
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H2034 - Halfway House Services, per Diem |
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H2034, HF - Residential Rehab Type II, per Diem |
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H2036 - Extended Care, per Diem |
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H2036, HA - Adolescent Residential Rehab, per Diem |
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H2036, HF - Residential Rehab Type I, per Diem |
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Section 97, Appendix C – Residential Care Facility PNMIs |
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Procedure Code, Modifiers - Description |
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0940/T1020 - Direct Care Services |
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Section 97, Appendix D – Children Residential Care Facility PNMIs (Limited to In-State Providers) |
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Procedure Code, Modifiers - Description |
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H0019, HA - Crisis Stabilization, per Diem |
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H0019, HE - MH Residential Tx, per Diem |
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H0019, HI - ID/DD Residential Tx, per Diem |
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99510, HR - Aftercare, 15 min |
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A0425, HI - Aftercare Mileage, per Mile |
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Section 97, Appendix E – Mental Illness PNMIs |
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Revenue/Procedure Codes - Description |
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0940/H0019 - Treatment |
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0940/T1020, HE - Personal Care |
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Section 97, Appendix F - Non-Case Mixed Medical and Remedial |
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Revenue/Procedure Codes - Description |
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0940/0242 - Treatment |
As a reminder, some rates are calculated based on costs at the individual provider level and as such may result in differing reductions.
REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2023, Ch 643, An Act to Make Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and to Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2024 and June 30, 2025
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral.
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. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location.
CONTACT INFORMATION
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
Email: Kristin.Merrill@maine.gov
Comment deadline:
On