[font=font36821]**IN THE FUTURE, METHODOLOGY NOTICES WILL ONLY BE PUBLISHED ONLINE AT: http://www.maine.gov/dhhs/oms/rules/stateplan/[/font]
[font=font36821]AGENCY:[/font] Department of Health and Human Services, Office of MaineCare Services
[font=font36821]AFFECTED SERVICES:[/font] Chapter 101, MaineCare Benefits Manual, Section 95, Podiatric Services
[font=font36821]NATURE OF PROPOSED CHANGES:[/font] The Department of Health and Human Services will request approval from the Centers for Medicare and Medicaid Services to reimburse Podiatric Service reimbursement as:
The fee schedule reimburses at the lowest of the following for covered services: 1) The lowest amount allowed by Medicare Part B for Maine area "99" fee, 2) 47.70% of the 2005 Medicare Part B for Maine area "99" fee or 47.70% of the rate in the first year that Medicare assigned a rate for the code, or 3) Where no other options are applicable, the Department will research other State Medicaid agencies that cover the relevant service/code and base its rates on the average cost of the relevant services/codes from those other agencies. If the provider's usual and customary charge for a service is lower than the fee schedule rate, the provider's usual and customary charge will be reimbursed.
The following code will be added to Section 95, Podiatric Services: 97762, [font=font57991]Checkout for orthotic/prosthetic use, established patient, each 15 minutes.[/font] Reimbursement will be $11.48 for non-facilities, and $7.79 facilities.
[font=font36821]REASON FOR PROPOSED CHANGES:[/font] The new language is being added in order to more fully explain the State's reimbursement methodology and does not reflect a change in reimbursement. A service/code is also added to allow providers to bill for this service.
[font=font36821]ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES:[/font] The Department does not anticipate that this change will have any fiscal impact.
[font=font36821]ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES:[/font] 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.
[font=font36821]CONTACT INFORMATION
FOR RECEIPT OF COMMENTS:[/font] Olivia Alford
[font=font36821]AGENCY NAME:[/font] Office of MaineCare Services
[font=font36821]ADDRESS:[/font] 242 State Street, 11 State House Station
Augusta, Maine 04333-0011
[font=font36821]TELEPHONE:[/font] (207) 624-4059 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.
Sept. 13, 2016
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