MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services
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 Proposal. 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 Proposal
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY: This proposed rulemaking seeks to make the following changes:
- Removes the requirement that providers may deliver covered services through telephonic telehealth only 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 proposes to remove 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.
- Allows members to provide written, verbal, or electronic consent to telehealth services; this change aligns the rule with P.L. 2021, Ch. 219.
- 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 proposes to allow a provider to bill the originating facility fee if the originating site is somewhere other than a provider’s facility.
- 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.
- 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.
- Removes the table of codes and rates in Section 4.07-4, Reimbursement Rates, because codes and rates reside and are updated in the appropriate Sections of the MBM or fee schedules on the MaineCare Health PAS Portal.
- Adds guidance to use the modifier “93” when billing for services delivered through telephonic telehealth.
- 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.Removes references to the requirement that a primary care referral is needed to see a specialist because this requirement is no longer in effect.
- 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.
- Clarifies 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.
- In Section 4.05(B)(2), adds examples of services that require direct physical contact and cannot be delivered through telehealth.
- The Department also removed an unused definition and made minor technical corrections.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; P.L. 2021, Ch. 291
DATE, TIME, AND PLACE OF PUBLIC HEARING: 1:00pm; Thursday, July 6, 2023
The Department will hold a combined in-person and remote (via Zoom) public hearing.
Location: State Office Building, Conference Rooms Maine A and Maine B
109 Capitol Street, Augusta, ME
Zoom Meeting link: https://mainestate.zoom.us/j/82109155776
Meeting ID: 821 0915 5776
Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to attend the hearing in person contact the agency person listed below 5 days in advance of the hearing.
In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on July 16, 2023.
AGENCY CONTACT PERSON: Henry Eckerson, Comprehensive Health Planner II
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
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A
STATUTORY AUTHORITY FOR THIS RULE: 22 M.R.S. §§ 42, 3173; P.L. 2021, Ch. 291
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