MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services

Nov 06, 2023

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes.  The MaineCare Benefits Manual is available on-line at the Secretary of State’s website. 

Below, please find a MaineCare Notice of Agency Rule-making Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.

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Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual,Chapter I, Section 4, Telehealth Services

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

This adopted rule makes the following changes:

1. Removes the requirement that providers may only deliver covered services through telephonic telehealth if interactive telehealth services are unavailable. This change aligns the rule with P.L. 2021, Ch. 219, An Act Regarding Telehealth Regulations. The Department also removes Section 4.04-3, Telephonic Services, because the requirements for telephonic and interactive telehealth services are now the same. Services delivered via telephonic telehealth must still be medically necessary, pursuant to Chapter I, Section 1.06-1.

2. Allows members to provide written, verbal, or electronic consent to telehealth services; this change aligns the rule with P.L. 2021, Ch. 219, as codified in 22 M.R.S. Sec. 3173-H.

3. Removes the restriction in Sections 4.07-2(B)(8) and 4.05(E) that the originating facility fee may only be billed when the originating site is in a health care provider’s facility. The Department allows a provider to bill the originating facility fee if the originating site is somewhere other than a provider’s facility.

4. Removes language in Section 4.07-2(B)(1) that suggests the originating facility fee is billable only if the provider makes room and telecommunications equipment available and clarifies that it is billable when a provider supports access to telehealth services. The rule also clarifies what supporting access to telehealth services means.

5. Removes a list of services that may not be delivered through telehealth. Section 4.04, Covered Services, defines requirements for what can be delivered through telehealth: it is impractical to maintain an all-encompassing list of services that cannot be delivered through telehealth and keeping a partial list in the rule creates ambiguity.

6. Removes the table of codes and rates in Section 4.07-4, Reimbursement Rates, because codes and rates reside and are updated either in the appropriate Sections of the MBM or the MaineCare provider fee schedules on the MaineCare Health PAS Portal. The Department is retaining reference to the originating facility fee under Section 4.07-4, Reimbursement Rates, because it is reimbursed under this rule. The Department added a sentence explaining that the specific rate for the Telehealth Originating Facility Fee, per visit, is listed on the MaineCare provider fee schedule, which is posted on the Department’s website in accordance with 22 MRSA Section 3173-J(7). Note that the specific rate for the Telehealth Originating Facility Fee can be changed or updated only through APA rulemaking, pursuant to 22 M.R.S. Sec. 3173-J(3).
7. Adds guidance to use the modifier “93” when billing for services delivered through telephonic telehealth.

8. Modifies the definition of Originating (Member) Site to clarify that it is not limited to a health care provider’s office or a member’s residence.

9. Removes references to the requirement that a primary care referral is needed to see a specialist because this requirement is no longer in effect.

10. Moves the content in Sections 4.06-2(A)(5-7) to new Sections 4.06-2(C-E) and makes edits to clarify the requirements. 

11. Added the requirement, in Section 4.03-1, that health care providers must be appropriately licensed, accredited, certified, and/or registered in the State where the member is located during the provision of the telehealth service.

12. In Section 4.05(B)(2), adds examples of services that require direct physical contact and cannot be delivered through telehealth.

13. The Department also removed the definition for “Requesting Physician” as this is not a relevant term for this rule. The Department also made minor technical corrections.

See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE: November 6, 2023

STATUTORY AUTHORITY: 22 MRS §§ 42, 3173; P.L. 2021, ch. 291, as codified in 22 M.R.S. Sec. 3173-H; 22 M.R.S. Sec. 3173-J

AGENCY CONTACT PERSON:         Henry Eckerson, Children’s and Behavioral Health Policy Manager

AGENCY NAME:                                 MaineCare Services

ADDRESS:                                            109 Capitol Street                                                             

                                                              11 State House Station

                                                              Augusta, Maine 04333-0011

EMAIL:                                                  henry.eckerson@maine.gov 

TELEPHONE:                                       207-624-4085 FAX: (207) 287-6106

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