№ lp_1_2_30122
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Character count: 55966
File size: 125 KB
This document outlines the definitions and eligibility requirements for various home health care services under the MaineCare program, detailing the processes and standards for authorization, certification, and reimbursement for services.
Year:
2023
Region / City:
Maine
Subject:
Home Health Care Services
Document Type:
Regulations
Agency:
MaineCare
Author:
Maine Department of Health and Human Services
Target Audience:
Healthcare providers, home health agencies, certified home health aides, and healthcare professionals involved in home care services
Effective Period:
Ongoing
Approval Date:
N/A
Date of Amendments:
N/A
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Year:
2025
Region / City:
Maine
Theme:
Healthcare, Medicaid
Document Type:
Manual
Institution:
Department of Health and Human Services, Office for Family Independence
Author:
State of Maine
Target Audience:
General public, healthcare professionals, individuals seeking MaineCare benefits
Period of Validity:
Until April 29, 2025
Approval Date:
April 29, 2025
Date of Changes:
Not specified
Year:
2025
Region / City:
Maine
Topic:
Healthcare Eligibility
Document Type:
Manual
Organization:
Department of Health and Human Services, Office for Family Independence
Author:
Unknown
Target Audience:
State officials, healthcare providers, and applicants for MaineCare
Period of Validity:
Effective April 29, 2025
Approval Date:
Not specified
Date of Last Update:
April 29, 2025
Contextual Description:
A policy manual providing eligibility criteria and administrative processes for MaineCare, including coverage groups, benefits, and eligibility verification methods.
Year:
N/A
Region / City:
Maine
Topic:
Medicaid Administration
Document Type:
Policy Manual
Organization / Institution:
Maine Department of Health and Human Services
Author:
N/A
Target Audience:
Health Providers, MaineCare Participants
Validity Period:
N/A
Approval Date:
N/A
Modification Date:
N/A
Note:
Year
Subject:
Speech and Hearing Services
Document Type:
Policy
Organization:
MaineCare
Target Audience:
Healthcare Providers, Speech and Hearing Professionals
Context Description:
Policy detailing specific billing codes and modifiers for speech and hearing services covered under MaineCare, including professional rates for various diagnostic and treatment procedures.
Jurisdiction:
State of Maine, United States
Program:
MaineCare
Governing Law:
Title XVIII, XIX, and XXI of the Social Security Act; 42 U.S.C.A. §§1395 et seq.; 42 U.S.C.A. §§1396 et seq.; 42 U.S.C. §1397; 22 M.R.S. §§10, 12, 42(1), 3173 et seq.; 22 M.R.S. §1901 et seq.; 22 M.R.S. §3174-T
Administering Authority:
Maine Department of Health and Human Services
Federal Oversight:
Centers for Medicare and Medicaid Services (CMS)
Document Type:
Benefits manual / administrative regulations
Subject:
Administration, provider participation, member eligibility, covered services, reimbursement, compliance, appeals, and program integrity
Related Programs:
Medicare; Medicaid; State Children’s Health Insurance Program (CHIP); Cub Care Program
Responsible Units:
Office for Family Independence; Program Integrity Unit; Division of Audit; Office of MaineCare Services
Scope:
Statewide administration of MaineCare benefits and services
Year:
2023
Region / City:
Maine
Theme:
Health care services
Document type:
Policy
Agency:
MaineCare
Author:
Maine Department of Health and Human Services
Target audience:
MaineCare providers and beneficiaries
Period of validity:
Ongoing
Approval date:
N/A
Amendment date:
N/A
Year:
2022
Region / City:
Maine
Theme:
Healthcare Services for Children and Adolescents
Document Type:
Guidelines
Organization:
MaineCare
Author:
Maine Department of Health and Human Services
Target Audience:
Healthcare Providers, MaineCare Members, and Their Caregivers
Effective Period:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2015
Region / City:
Maine
Topic:
Non-Emergency Transportation
Document Type:
Policy and Procedure
Organization / Institution:
Maine Department of Health and Human Services
Author:
MaineCare Services
Target Audience:
MaineCare Members, Transportation Providers, Brokers
Effective Period:
From 4/5/2015
Approval Date:
4/5/2015
Date of Last Update:
4/5/2015
Effective Date:
11/18/14
Program:
MaineCare
Jurisdiction:
Maine
Country:
United States
Issuing Authority:
Department of Health and Human Services
Regulatory References:
45 C.F.R. §162.1000; 45 C.F.R. §1011; 42 C.F.R. §447.205
Related Agency:
Centers for Medicare and Medicaid Services (CMS)
Document Type:
Reimbursement rate schedule and billing code list
Subject:
Family planning services and related medical procedures
Code System:
Healthcare Common Procedure Coding System (HCPCS)
Update Frequency:
Approximately quarterly updates issued by CMS
Provider Requirements:
Use of FP modifier for applicable services; CLIA-waiver certificate required for certain laboratory codes
Reimbursement Basis:
Fee-for-service rates
State Plan Requirement:
Payment subject to approval of a state plan amendment by CMS
Publication Method:
Notices of reimbursement methodology change and revised billing instructions
Web Reference:
www.maine.gov/dhhs/audit/rate-setting/index.shtml
Year:
2012
Region / City:
Maine
Topic:
Occupational Therapy Services
Document Type:
Policy document
Organization:
MaineCare
Author:
MaineCare
Target Audience:
Healthcare providers and occupational therapists
Period of Validity:
Ongoing
Approval Date:
06/29/12
Modification Date:
None
Year:
2026
Region:
Maine, USA
Topic:
Healthcare Payment and Delivery Model
Document Type:
Policy and Program Manual
Organization:
Maine Department of Health and Human Services
Author:
MaineCare Program Administration
Target Audience:
Primary Care Providers and MaineCare Members
Participation:
Voluntary for both providers and members
Payment Model:
Population-Based Payments with Performance-Based Adjustments
Implementation Period:
Ongoing
Certification Reference:
CEHRT under 42 CFR §414.1305
Legal Authority:
Social Security Act Section 1905(t)(1)
Scope:
Primary care, behavioral health integration, care plans, and community health workers
Operational Structure:
Accountable Communities, Joint Care Management, Community Care Teams
Risk Assessment:
Member attribution, risk scores, and performance measures
Reimbursement Mechanism:
Tiered PBPs and quarterly PBAs
Year:
2025
Note:
Region / City
Theme:
Data definitions, Medical records, Extract files
Document Type:
Technical document
Organization / Institution:
Department of Veterans Affairs Office of Information and Technology
Author:
Booz Allen Hamilton, Liberty IT Solutions
Target Audience:
DSS/MCA teams, IT professionals
Contextual description:
This document provides technical details on data extraction routines and data definitions for various medical records files used in the Decision Support System.
Year:
2021
Region / City:
United States
Topic:
Human Trafficking Prevention Education
Document Type:
Grant Program Guide
Organization / Institution:
Office on Trafficking In Persons (OTIP)
Author:
OTIP
Target Audience:
Local educational agencies (LEAs), school staff, trainers, NGOs
Period of Validity:
Ongoing, based on program updates
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
No year specified
Region / City:
Washington County, MN
Topic:
Family Support Grant Funding
Document Type:
Grant Expense Guidelines
Organ / Institution:
Washington County, MN
Author:
Not specified
Target Audience:
Families with children with disabilities
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Context:
A guideline document outlining the categories of expenses eligible for reimbursement under the Family Support Grant Program for families with children with disabilities.
Year:
2009
Region / City:
United States
Topic:
Legal definitions in the Uniform Commercial Code
Document Type:
Legal text
Authority / Institution:
United States legal system
Author:
Not specified
Target Audience:
Legal professionals, businesses, and individuals involved in commercial transactions
Period of validity:
Ongoing, subject to amendments
Date of approval:
2009
Date of amendments:
2023
Date:
03/31/2025
Region / City:
Texas
Topic:
Actuarial Standards
Document Type:
Amendment Proposal
Organization / Institution:
Texas Department of Insurance
Author:
Rachel Hemphill
Target Audience:
Actuaries, Insurance Commissioners, Regulatory Authorities
Effective Period:
N/A
Approval Date:
N/A
Date of Changes:
N/A
Year:
2025
Note:
Region / City
Topic:
Overdose Case Definitions
Document Type:
Guideline
Organization:
NEMSIS
Target Audience:
EMS Providers, Medical Personnel
Year:
2023
Region / City:
Humber and North Yorkshire
Theme:
Medicine prescribing, healthcare guidelines
Document Type:
Guideline, formulary
Organization / Institution:
Humber and North Yorkshire Area Prescribing Committee
Author:
Humber and North Yorkshire Area Prescribing Committee
Target Audience:
Healthcare professionals (pharmacists, doctors, primary and secondary care providers)
Period of Validity:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
Not specified
Region / City:
Not specified
Topic:
Brain Injury Rehabilitation
Document Type:
Rule
Organ / Institution:
Department (unspecified)
Author:
Not specified
Target Audience:
Service providers and professionals in brain injury rehabilitation
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year