C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-71, subsec. 144-101-II-71.06

Current through 2024-51, December 18, 2024
Subsection 144-101-II-71.06 - POLICIES AND PROCEDURES
A.Enrollment. Providers shall enroll as MaineCare providers at the organizational level. Organizations that do not have a National Provider Identification (NPI) number must obtain one through the National Plan & Provider Enumeration System to enroll.
B.Unenrolled Locations. Providers that deliver sessions at one or more service locations that are not enrolled with MaineCare (unenrolled locations), such as a community center, shall retain a list of these locations that includes the dates of the first and last day, as applicable, that the Provider delivered a session at each location. Providers shall send the list to MaineCare's Section 71 provider relations specialist and shall update and resend the list prior to delivering sessions at a new unenrolled location and immediately after discontinuing delivering sessions at an unenrolled location. Providers billing for National DPP LCP sessions delivered at an unenrolled location shall use place of service code "99" on the claim.
C.Family Member, Support Person, or Guardian Participation. Providers shall allow a family member, guardian, or support person to join sessions if a member requires assistance in order to participate. Providers shall not bill for a family member, guardian, or support person who accompanies a member during sessions unless that person is also enrolled in the program and is also a MaineCare member.
D.Cohorts. National DPP LCP cohorts, described in the DPRP Standards, may include nonMaineCare enrolled participants. Providers cannot bill MaineCare for delivering sessions to nonMaineCare enrolled participants.
E.Scales. Providers shall provide and deliver a scale to measure weight to any participating member who reports they do not have access to and cannot obtain a scale.
F.Third Party Liability. Providers enrolled with Medicare or any other primary payer to deliver the MDPP or the National DPP LCP shall bill the primary payer before billing MaineCare for National DPP LCP sessions, unless the participant has already reached their lifetime MDPP or National DPP LCP benefit maximum.
G.Make-up Sessions. Providers may offer make-up sessions in accordance with DPRP Standards.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-71, subsec. 144-101-II-71.06