№ files_lp_3_process_7_041786
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Official state reimbursement rate schedule listing billing codes, modifiers, regulatory conditions, and payment amounts for family planning and related clinical services under MaineCare as of 11/18/14.
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
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The product description is provided for reference. Actual content and formatting may differ slightly.
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:
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
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
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:
2023
Region / City:
United States
Topic:
Health Data Collection, Public Health Research, Survey Design
Document Type:
Federal Notice
Agency:
Centers for Disease Control and Prevention (CDC)
Author:
Centers for Disease Control and Prevention (CDC)
Target Audience:
Public, Federal Agencies, Health Researchers
Period of Effect:
Ongoing, with quarterly surveys
Approval Date:
06/30/2022
Modification Date:
Not specified
Year:
2022
Region / City:
Canberra
Topic:
Healthcare billing guidelines
Document Type:
Guideline
Organization / Institution:
Canberra Health Services
Author:
Canberra Health Services
Target Audience:
Clinical and administrative staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2025
Region / City:
California
Topic:
Specialty Mental Health Services Billing
Document Type:
Manual
Organization / Institution:
Department of Health Care Services (DHCS)
Author:
Department of Health Care Services
Target Audience:
Mental Health Plans (MHP), Billing Vendors, Providers of Specialty Mental Health Services
Effective Period:
SFY 2025-26
Approval Date:
July 2025
Amendment Date:
Not specified
Note:
Year
Theme:
Billing Account Name Change
Document Type:
Instructional Guide
Organization / Institution:
Microsoft
Target Audience:
Microsoft customers requesting Billing Account name changes
Year:
2023
Region / City:
Massachusetts
Topic:
Intensive Community Services, Billing Procedures
Document Type:
Guidelines
Organization / Institution:
Massachusetts Department of Mental Health
Author:
Massachusetts Department of Mental Health
Target Audience:
Service Providers
Period of Validity:
Ongoing
Approval Date:
6/14/23
Date of Changes:
Not specified
Program:
Home and Community-based Services (HCS)
Document type:
Billing requirements
Governing body:
Health and Human Services Commission
Jurisdiction:
Texas
Legal basis:
40 TAC §9.170
Provider obligations:
Service claim preparation and submission
Effective dates:
January 1, 2023; March 1, 2023; November 15, 2019; September 1, 2021
Revision identifiers:
Revision 19-1; Revision 21-3; Revision 23-1; Revision 23-2
Service components covered:
Professional therapies, residential assistance, respite, nursing, employment services, adaptive aids, home modifications, dental treatment, transition assistance
Compliance oversight:
Provider Fiscal Compliance Reviews
Appendices included:
Provider Fiscal Compliance Review Protocol, forms, revisions, contact information
Year:
2022
Region / City:
Victoria, Australia
Topic:
Healthcare policy, Medicare billing
Document type:
Policy guidelines
Agency / Institution:
Department of Health, Victorian Government
Author:
Victorian Department of Health
Target audience:
Public hospitals, health practitioners, hospital administrators
Effective period:
Ongoing
Approval date:
July 2022
Revision history:
Not specified
Note:
Date
Email:
[email protected]
FAX:
866-942-7487
Mail:
Dignity Health IZ request, PO Box 3008, Rancho Cordova, CA 95741
Year:
2020
Region / City:
Pennsylvania
Topic:
Billing Document Cancellation
Document Type:
Instructional Guide
Organization / Institution:
The Pennsylvania State University
Author:
Labyrinth Solutions, Inc.
Target Audience:
Penn State Staff and Users
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Note:
Context Description