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As a reminder for all providers of PDN services for members under the age of 21, the determination of medical necessity for PDN services in the home should not be contingent on whether the member receives PDN services at school.
There are two ways you can update your claims to get reimbursed for a retro rate increase.
You can do a straight reversal, which takes back the original payment and allows you to bill a new clean claim. You have one year from the date of service to submit a correct claim.
MaineCare is expanding Dental Services to include coverage for adults, investing in reimbursement rates, and updating the entire policy to make it consistent with up-to-date evidence-based procedures and practices. These changes will take effect on July 1, 2022, by emergency rulemaking. Emergency rules have a maximum effective period of 90 days. The Department will propose a routine technical rule within 7 to 14 days of the emergency rule to make these changes permanent.
Good afternoon,
We continue to field questions, conduct training, and see submissions of the DHHS Telework Approval Forms. Many thanks to all of you who have participated to date. As a reminder, you have until next Friday, July 1 to fill out an Approval Form to seek approval to continue teleworking after September 6.
The Department recently adopted amendments to Section 21 rules (10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 21). The rules clarified longstanding policy related to overnight staff in group homes.
This message is another reminder about the Electronic Visit Verification (EVV) “soft launch” period for providers of section 40 Home Health and section 43 Hospice services ahead of the January 1, 2023 federal implementation deadline that was originally announced August 13, 2021.
Appendix K to Maine’s Home and Community-Based Services 1915(c) waivers provides the state certain flexibilities in waiver program operations during an emergency. Maine’s Appendix K and amendments may be found here.
In certain exceptional and high-risk situations for youth under the age of 21, the Office of MaineCare Services (OMS) will approve a MaineCare member’s clinical eligibility for services in a Children’s Residential Care Facility (CRCF) under the Early Periodic Screening Diagnostic and Treatment (EPSDT) benefit, MaineCare Benefits Manual (MBM) Chapter II, Section 94, without requiring an attempt to use a lower level of care.