Rate Determination Initiation and Rate Study Kickoff Meeting Notice for Home and Community Based Supports for Individuals with Intellectual and Developmental Disabilities or Autism, Sections 21 and 29, and Proposed Lifespan Waiver

This bulletin provides notice that the Department has initiated a Rate Determination Process* for Home and Community Based Supports for Individuals with Intellectual and Developmental Disabilities or Autism, Sections 21 and 29, and a new proposed Lifespan waiver service.

Public Forum Postponed: Attention Section 97, Private Non-Medical Institutions (PNMI), Appendix D, Therapeutic Foster Care (TFC) Services: Draft Rate Model Public Review and Comment​

Rule Adoption: 10-144 CMR chapter 264, Immunization Requirements for Healthcare Workers

The Department has adopted routine technical rule changes that amend Chapter 264, Immunization Requirements for Healthcare Workers, by removing COVID-19 from the list of vaccine preventable diseases for which Designated Healthcare Facility employees must show proof of immunization or provide appropriate exemption documentation. Public comments were considered prior to adopting the final rule. The adopted rule is consistent with the proposed rule published for public comment on July 19, 2023.

10-144 CMR Ch. 123, Behavioral Health Organizations Licensing Rule

The Department is proposing the repeal of three existing licensing rules and replacing those rules with one single rule, Behavioral Health Organizations Licensing Rule, to provide a comprehensive, one-stop licensing rule. This proposed rule governs the licensing requirements for mental health and substance use disorder treatment programs. The rules proposed for repeal and replacement include community and residential licensing standards for mental health and substance use disorder treatment services.

Add Codes to the TPL Vision Services Group, CR 119556

MaineCare has identified a claim processing error. MaineCare is the payor of last resort. Providers are required to bill the primary vision insurance before billing MaineCare. Vision service codes have been paying as MaineCare primary when the Member has an active primary vision insurance carrier that has not been billed. MaineCare will reprocess claims with overpaid services and recoup the overpayment. No provider action is needed.  

Microdyn Update for Ambulatory Payment Classifications (APCs), and Diagnostic Related Groups (DRG’s), CRs 119337, 119338, & 119340

Effective August 19, 2023, we have made the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates in MIHMS.        

The following CMS document provides the details of the APC updates:       

July 2023 Integrated Outpatient Code Editor Specs:     

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