Emergency Rulemaking

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MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services Word  PDF 
Concise Summary: This emergency rulemaking updates the supplemental pool amount and method for distributing that pool to Non-Critical Access and other hospitals to better align with Diagnosis Related Group reimbursement. Effective April 24, 2012, the Department is decreasing the supplemental pool for Non-Critical Access, Rehabilitation Hospitals and Hospitals Reclassified to a Wage Area Outside Maine from $51,847,218 to $51,642,035. The distribution methodology for that pool is also being amended from a system based solely on the relative share of MaineCare discharges to one that also uses the relative share of MaineCare days. The Department is also making caps on Prospective Interim Payments (PIP) consistent across the system so that the total payment to all hospitals receiving a PIP is not less than 70% of the calculated amount of the total PIP for the current year.
Effective Date: April 24, 2012
 
MaineCare Benefits Manual, Chapter II, Section 80, Pharmacy Services WORD  PDF 
Concise Summary: This emergency rule is being adopted pursuant to Public Law, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 26, 2012, which directed the Department to reduce the current limitations on brand name drugs to allow a member to receive a total of two (2) brand name drugs per month when a generic equivalent is available. In addition, the Department is making additional changes to this rule as identified in the Department’s Administrative Savings proposals. These initiatives are part of a range of adjustments that the Department is making through the adopted 2012 Supplemental Budget, to include: a discontinuation of reimbursement for nutritional products through retail pharmacies and reduction of reimbursement for brand-name medications provided at a retail pharmacy from the current methodology of Average Wholesale Price (AWP) minus (-) fifteen percent (15%) to AWP minus (-) sixteen percent (16%). This rulemaking includes other changes that will achieve savings, or support the Department in achieving savings, but are not directly included in the DHHS Supplemental Budget. This rulemaking adds criteria for early refills for mail order prescriptions in excess of a ninety percent (90%) threshold, which is expected to achieve cost savings. The Department will also add Wholesale Acquisition Cost reimbursement methodology for generic, brand name and specialty medications as a reimbursement methodology. Finally, the Department is adding a provision that a provider may be limited to billing based on the Federal Upper Limit (FUL) unless the Department meets FUL in the aggregate, which is automatically calculated at the point of sale. The Department requires pharmacy providers to bill at the lowest of the reimbursement methodologies listed in the rule, therefore, the inclusion of WAC as a reimbursement methodology and the addition of language allowing providers to bill based on FUL, unless the Department meets FUL in the aggregate, is expected to result in cost savings. Finally, this rulemaking will include a change that was previously enacted through an emergency rulemaking, effective February 1, 2012, that increased the dispensing fee for mail-order pharmacies from one-dollar ($1.00) to two-dollars and fifty cents ($2.50). This change is included in this rulemaking in order to avoid two separate emergency rules existing for the same section of policy at one time. The effective date for this change will begin again upon enactment of this emergency rule.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services WORD  PDF 
Concise Summary: The emergency adopted rule specifies that the weekly rate for Opioid Treatment (Methadone) is reduced from $72.00 to $60.00 per week.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 2, Adult Family Care Services WORD  PDF 
Concise Summary: This emergency rule is being adopted pursuant to Public Law, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012, which directed the Department to reduce reimbursement of Adult Family Care Services by 10%. This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Section 95, Chapter II, Podiatric Services WORD  PDF 
Concise Summary: This emergency rule is being adopted pursuant to Public Law 2011, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012, which directs the Department to reduce reimbursement of MaineCare Podiatric Services by ten percent (10%). This change is not expected to have an adverse effect on the administrative burdens of small businesses.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Section 75, Chapter II, Vision Services WORD  PDF 
Concise Summary: The Department is adopting the following changes for Chapter 101, MaineCare Benefits Manual, Section 75, Chapter II, Vision Services, pursuant to Public Law 2011, Chapter 477, the Maine State Supplemental Budget enacted by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012. This emergency rule is being adopted in accordance with Part M of the Supplemental Budget, requiring that, effective April 1, 2012, MaineCare Services reimburse for only one (1) routine eye exam every three (3) rolling calendar years for members ages twenty-one (21) and over. Routine eye exams indicated as the standard of care for specific medical diagnoses (ex. diabetes) or for high-risk medication use (ex. Plaquinil) will continue to be covered as medically indicated. The enactment of this emergency rule is estimated to save $23,708 for State Fiscal Year (SFY) 2012 and $126,442 for SFY 2013, respectively.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Section 15, Chapter II, Chiropractic Services WORD  PDF 
Concise Summary: : The Department is adopting changes to Chapter 101, MaineCare Benefits Manual, Section 15, Chapter II, Chiropractic Services pursuant to Public Law 2011, Chapter 477, the Maine State Supplemental Budget enacted by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012. This emergency rule is being adopted in accordance with Part M, requiring that effective April 1, 2012, MaineCare Services reimburse Section 15, Chiropractic Services only up to a strict limit of twelve (12) visits per rolling calendar year for adult members. The adoption of this emergency rule is estimated to save $29,072 for State Fiscal Year (SFY) 2012 and $157,805 for SFY 2013, respectively
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 68, Occupational Therapy Services WORD  PDF 
Concise Summary: This emergency rule is being adopted pursuant to Public Law 2011, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012. Part M-1 requires the Department to reduce MaineCare reimbursement of Occupational Therapy Services by ten percent (10%). Part EE-1 authorizes the Department to promulgate this rule by emergency rulemaking.
Effective Date: April 1, 2012
 
Chapter 101, MaineCare Benefits Manual, Section 85, Chapter III, Physical Therapy Services WORD  PDF 
Concise Summary: This emergency rule is being adopted pursuant to Public Law 2011, Chapter 477, LD 1816, the Maine State Supplemental Budget passed by the 125th Maine State Legislature and signed into law by Governor Paul R. LePage on February 23, 2012. Part EE-1 authorizes the Department to promulgate this rule by emergency rulemaking. Part M-1 requires the Department to reduce MaineCare reimbursement of Physical Therapy Services by ten percent (10%) effective April 1, 2012.
Effective Date: April 1, 2012
 
MaineCare Benefits Manual, Chapter III, Section 32, Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF 
Concise Summary: The emergency adopted rule creates a new Section of the MaineCare Benefits Manual that will be known as Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders. These services are provided to members through a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services (CMS). Chapter III establishes billing procedure codes based on HIPAA compliant CPT coding. Services will be provided to children with Intellectual Disabilities or Pervasive Developmental Disorders to support them to live in the community rather than in institutional settings. This change is not expected to have an adverse effect on the administrative burdens of small businesses. This emergency rule is a companion to an emergency rule that establishes the rules for delivering these services in Maine Care Benefits Manual Ch. II, Section 32. This rule will be provisionally adopted pending approval by the Legislature.
Effective Date: July 1, 2011
 
MaineCare Benefits Manual, Chapter II, Section 32, Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders WORD  PDF 
Concise Summary: The Emergency Adopted rule creates a new Section of the MaineCare Benefits Manual that will be known as Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders. These services are provided to children under a Home and Community Based Waiver program approved by the Centers for Medicare and Medicaid Services (CMS). Services in Chapter II include Home Support, Home Accessibility Adaptations, Transportation, Consultation, Communication Aids and Respite Care. Services will be provided to children with Intellectual Disabilities or Pervasive Developmental Disorders to support them to live in the community rather than in institutional settings. This change is not expected to have an adverse effect on the administrative burdens of small businesses. This emergency rule is a companion to an emergency major substantive rule that establishes rates for services in MaineCare Benefits Manual Ch. III, Section 32.
Effective Date: July 1, 2011
 
Adopted Emergency Rule: MaineCare Benefits Manual, Chapter 101, Chapter III, Section 23, Developmental and Behavioral Clinic Services word 
Concise Summary: The Department is adopting an emergency rule for MaineCare Benefits Manual, Chapter 101, Chapter III, Section 23, Developmental and Behavioral Clinic Services pursuant to PL 2009, CH 571, Part A and Part OOO, § 000-1 (June 2010 State of Maine Supplemental Budget). The reductions in reimbursement set forth in these rules were selected after consideration by the Legislature. The Department is required to reduce the fees set forth in this policy by 10%, effective 07/01/2010. Therefore a 10% reduction to services has been applied to rates in this policy.
Effective Date: 2010-07-01
 

 

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