Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
AFFECTED SERVICES: Chapter 101, MaineCare Benefits Manual, Section 96, Private Duty Nursing and Personal Care Services; Section 12, Consumer Directed Attendant Services.
NATURE OF PROPOSED CHANGES:
The Department of Health and Human Services (DHHS) will request approval from the Centers for Medicare and Medicaid Services to increase reimbursement for personal care and related services, pursuant to Public Law 2016, Chapter 83 Resolves.
Reimbursement will be as follows:
Procedure Code
Description
Unit
Amount
Section 96, Private Duty Nursing and Personal Care Services
G0299 TD 0551
RN Services
15 min
$12.16
G0299 TD UN 0551
RN Services - multiple patients (2)
15 min
$6.69
G0299 TD UP 0551
RN Services - multiple patients (3)
15 min
$4.87
G0300 TE 0559
LPN Services
15 min
$8.04
G0300 TE UN 0559
LPN Services - multiple patients (2)
15 min
$4.43
G0300 TE UP 0559
LPN Services - multiple patients (3)
15 min
$3.21
T1000 TD
Independent RN
15 min
$10.96
T1000 TD UN
Independent RN - multiple patients (2)
15 min
$6.03
T1000 TD UP
Independent RN - multiple patients (3)
15 min
$4.39
T1004 0571
Home Health Aide/ CNA Services
15 min
$4.90
T1004 UN 0571
Home Health Aide/CNA Services - multiple patients (2)
15 min
$2.70
T1004 UP 0571
Home Health Aide/CNA Services - multiple patients (3)
15 min
$1.96
T1019 0589
Personal Support Services
15 min
$4.10
T1019
Personal Support Services - (PCA Agencies only)
15 min
$4.62
T1019 UN
Personal Support Services - (PCA Agencies only) multiple patients (2)
15 min
$2.54
T1019 UP
Personal Support Services - (PCA Agencies only) multiple patients (3)
15 min
$1.84
S5125 TF 0589
PCA Supervisit
15 min
$5.10
S5125 UN 0589
PCA Supervisit - multiple patients (2)
15 min
$2.81
S5125 UP 0589
PCA Supervisit - multiple patients (3)
15 min
$2.04
S5125TF 0589
PCA Supervisit (PCA Agencies only)
15 min
$5.10
S5125 TF UN 0589
PCA Supervisit (PCA Agencies only) multiple patients (2)
15 min
$2.81
S5125 TF UP 0589
PCA Supervisit (PCA Agencies only) multiple patients (3)
15 min
$2.04
S5125
Personal Support Services (FPSO)
15 min
$3.72
S5125 UN
Personal Support Services (FPSO) multiple patients (2)
15 min
$2.04
S5125 UP
Personal Support Services (FPSO) multiple patients (3)
15 min
$1.49
Section 12, Consumer Directed Attendant Services
S5125 U2
Attendant Care Services
15 min
$3.33
S5125 U2 UN
Attendant Care Services 2 person
15 min
$1.83
S5125 U2 UP
Attendant Care Services 3 person
15 min
$1.33
*To avoid a reduction in services available to members receiving services under Section 96, Private Duty Nursing and Personal Care Services, DHHS will increase the applicable monthly cost caps to account only for the increase in reimbursement.
The monthly cost cap will be as follows:
Level I
$925
Level II
$1,165
Level III
$1,904
Level IV
$3,532
Level V
$23,966
Level VI
n/a
Level VII
n/a
Level VIII
$847
Level IX
$1,769
REASON FOR PROPOSED CHANGES: The Maine State Legislature mandated the Department to implement these increases in reimbursement pursuant to Public Law 2016, Chapter 83, Resolves.
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an estimated additional cost of $641,339 in Federal Fiscal Year 2016, which includes $239,412 in state dollars and $401,927 in federal dollars, and $3,848,033 in Federal Fiscal Year 2017, which includes $1,370,669 in state dollars and $2,477,364 in federal dollars.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location.
CONTACT INFORMATION
FOR RECEIPT OF COMMENTS: Olivia Alford
AGENCY NAME: Office of MaineCare Services
ADDRESS: 242 State Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4034 FAX: (207) 287-1864
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
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