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<title>Sections 2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024</title>
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<p class="MsoNormal">FYI<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">________________________________________ <br>
<br>
<b>Mary Adley, Ed.D.</b> <br>
Coordinator of State Agency Programs <br>
Office of Special Services & Inclusive Education <br>
23 State House Station <br>
Augusta, Maine 04333-0023 <br>
<b>Email: </b><a href="mailto:mary.adley@maine.gov"><span style="color:#467886">mary.adley@maine.gov</span></a>
<br>
<b>Phone</b>: 207-624-6671 <o:p></o:p></p>
<p class="MsoNormal" style="vertical-align:baseline"><span style="font-family:"Segoe UI",sans-serif"><a href="http://www.maine.gov/doe" target="_blank"><span style="font-family:"Aptos",sans-serif;color:#0070C0">Maine DOE</span></a></span> |
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<span style="font-family:"Segoe UI",sans-serif"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Collins, Trista <Trista.Collins@maine.gov>
<br>
<b>Sent:</b> Monday, August 5, 2024 5:31 PM<br>
<b>To:</b> Frazier, Erin <Erin.Frazier@maine.gov><br>
<b>Cc:</b> Adley, Mary <Mary.Adley@maine.gov>; McGowen, Barbara A <Barbara.A.McGowen@maine.gov><br>
<b>Subject:</b> FW: Sections 2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><a name="_Hlk158721504"><span style="font-size:11.0pt">FYI- MaineCare notice provider on rate adjustments from 1/1/2024<o:p></o:p></span></a></p>
<p class="MsoNormal"><span style="mso-bookmark:_Hlk158721504"><span style="font-size:11.0pt"><o:p> </o:p></span></span></p>
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<td width="120" valign="top" style="width:89.75pt;padding:0in 0in 0in 0in;height:67.45pt">
<p class="MsoNormal" style="line-height:105%;vertical-align:baseline"><span style="mso-bookmark:_Hlk158721504"><img border="0" width="107" height="74" style="width:1.1166in;height:.775in" id="Picture_x0020_1" src="cid:image001.jpg@01DAE75D.35600170"></span><span style="mso-bookmark:_Hlk158721504"><span style="font-size:9.0pt;line-height:105%;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></span></p>
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<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"><b><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;color:#005E9E;mso-ligatures:standardcontextual">Trista Collins<o:p></o:p></span></b></span></p>
<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual">State Medicaid Educational Liaison<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual">State of Maine, Office of MaineCare Services<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;color:#005E9E;mso-ligatures:standardcontextual">Phone:</span></span><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;color:#806000;mso-ligatures:standardcontextual">
</span></span><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual">(207) 624-4094<span style="color:#BF8F00"><o:p></o:p></span></span></span></p>
<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;color:#005E9E;mso-ligatures:standardcontextual">Address:</span></span><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual">
109 Capitol Street, Augusta, Maine 04333<i><o:p></o:p></i></span></span></p>
<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;color:#005E9E;mso-ligatures:standardcontextual">Email:</span></span><span style="mso-bookmark:_Hlk158721504"><span style="font-size:10.0pt;line-height:105%;font-family:"Arial",sans-serif;color:#806000;mso-ligatures:standardcontextual">
</span></span><a href="mailto:trista.collins@maine.gov"><span style="mso-bookmark:_Hlk158721504"><span style="color:#0563C1;mso-ligatures:standardcontextual">trista.collins@maine.gov</span></span><span style="mso-bookmark:_Hlk158721504"></span></a><span style="mso-bookmark:_Hlk158721504"><span style="mso-ligatures:standardcontextual"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height:105%"><span style="mso-bookmark:_Hlk158721504"></span><a href="https://www.maine.gov/dhhs/oms/providers/childrens-services/school-health-related-services"><span style="mso-bookmark:_Hlk158721504"><span style="color:#0563C1;mso-ligatures:standardcontextual">MaineCare
in Education</span></span><span style="mso-bookmark:_Hlk158721504"></span></a><span style="mso-bookmark:_Hlk158721504"><span style="mso-ligatures:standardcontextual"><o:p></o:p></span></span></p>
<span style="mso-bookmark:_Hlk158721504"></span>
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<p class="MsoNormal"><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual">Stay up to date on MaineCare’s latest news and changes. Visit
</span></i><span style="mso-ligatures:standardcontextual"><a href="https://public.govdelivery.com/accounts/MEHHS/subscriber/new?preferences"><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif">MaineCare's e-message subscription page</span></i></a></span><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:#002060;mso-ligatures:standardcontextual">
</span></i><i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual">to get updates by e-mail.</span></i><span style="font-size:9.0pt;font-family:"Arial",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Office of MaineCare Services <<a href="mailto:meoms@subscriptions.maine.gov">meoms@subscriptions.maine.gov</a>>
<br>
<b>Sent:</b> Monday, August 5, 2024 4:01 PM<br>
<b>To:</b> Collins, Trista <<a href="mailto:Trista.Collins@maine.gov">Trista.Collins@maine.gov</a>><br>
<b>Subject:</b> Sections 2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024<o:p></o:p></span></p>
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<p class="p1"><span style="mso-bookmark:gd_top"></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDIsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vY29udGVudC5nb3ZkZWxpdmVyeS5jb20vYWNjb3VudHMvTUVISFMvYnVsbGV0aW5zLzNhY2ZhNmU_cmVxZnJvbT1zaGFyZSIsImJ1bGxldGluX2lkIjoiMjAyNDA4MDUuOTg2MTQyNTEifQ.sWCggVYEp-y7De7RVFRcAJfugL2v-dCMAVNn35_z8hA/s/613002080/br/246943615582-l" target="_blank"><span style="mso-bookmark:gd_top"><span style="border:solid windowtext 1.0pt;padding:0in;text-decoration:none"><img border="0" width="83" height="16" style="width:.8666in;height:.1666in" id="Picture_x0020_2" src="cid:~WRD0000.jpg" alt="Image removed by sender. Bookmark and Share"></span></span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">You are subscribed to MaineCare - Long Term Care Services for Maine Department of Health & Human Services. This information has recently been updated, and is now available.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="mso-bookmark:gd_top"></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDMsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHA6Ly93d3cubWFpbmUuZ292L2RoaHMvb21zL3Byb3ZpZGVycy9wcm92aWRlci1idWxsZXRpbnMvc2VjdGlvbnMtMi0xMy0xNy0yNi0yOC1hbmQtNjUtaW1wbGVtZW50YXRpb24tY29zdC1saXZpbmctYWRqdXN0bWVudHMtY29sYXMtZWZmZWN0aXZlP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyNDA4MDUuOTg2MTQyNTEifQ.GYOHc_pnCigiBiTTbsMrLC_N0oI_wT5gGM2SXYyuuuw/s/613002080/br/246943615582-l"><span style="mso-bookmark:gd_top"><b><span style="font-size:14.5pt">Sections
2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024</span></b></span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"><b><span style="font-size:14.5pt"><o:p></o:p></span></b></span></p>
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<p class="MsoNormal"><span style="mso-bookmark:gd_top"></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDQsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHA6Ly93d3cubWFpbmUuZ292L2RoaHMvb21zL3Byb3ZpZGVycy9wcm92aWRlci1idWxsZXRpbnMvc2VjdGlvbnMtMi0xMy0xNy0yNi0yOC1hbmQtNjUtaW1wbGVtZW50YXRpb24tY29zdC1saXZpbmctYWRqdXN0bWVudHMtY29sYXMtZWZmZWN0aXZlP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyNDA4MDUuOTg2MTQyNTEifQ.odqBmwD1T5wqFMIyF3L5YiS1ps8apwf4BXdJbU2ubeY/s/613002080/br/246943615582-l"><span style="mso-bookmark:gd_top">Sections
2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024
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<p class="MsoNormal"><span style="mso-bookmark:gd_top">Aug 05, 2024<o:p></o:p></span></p>
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<p class="paragraph"><span style="mso-bookmark:gd_top">On December 1, 2023, MaineCare provided
</span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDUsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lm1haW5lLmdvdi9kaGhzL29tcy9wcm92aWRlcnMvcHJvdmlkZXItYnVsbGV0aW5zL3N1YmplY3QtbWFpbmVjYXJlLWNvc3QtbGl2aW5nLXBhcnQtYWFhYS1hZGp1c3RtZW50cy0yMDIzLTEyLTAxP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyNDA4MDUuOTg2MTQyNTEifQ.G-1sos2sRMErTU42CubvPeBHYhGW1HizE3uDyT9SW7c/s/613002080/br/246943615582-l"><span style="mso-bookmark:gd_top">notice</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top">
that it would increase reimbursement for certain eligible services through a 2.54% COLA, to be effective January 1, 2024. The notice indicated a status of “pending approval of appropriations” for several eligible services (under Sections 2, 13, 17, 26, 28,
and 65).<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">After a 90-day waiting period that began with the adjournment of the Legislature on May 10, 2024, the funding for these COLAs will be made available to the Department, and rates implemented for billing on August 9, 2024.<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">These new rates will be funded retroactively to January 1, 2024, and will reflect a 2.54% COLA. The updated fee schedules will be available for viewing on the
</span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDYsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vbWFpbmVjYXJlLm1haW5lLmdvdi9Qcm92aWRlciUyMEZlZSUyMFNjaGVkdWxlcy9Gb3Jtcy9QdWJsaWNhdGlvbi5hc3B4P0ZvbGRlckNUSUQ9MHgwMTIwMDAyNjREMUZCQTBDMkJCMjQ3QkY0MEEyQzU3MTYwMEU4MSZSb290Rm9sZGVyPSUyRlByb3ZpZGVyK0ZlZStTY2hlZHVsZXMlMkZSYXRlK1NldHRpbmcmVmlldz0lN0I2OUNFRTFENC1BNUNDLTREQUUtOTNCNi03MkE2NkRFMzY2RTAlN0QmdXRtX21lZGl1bT1lbWFpbCZ1dG1fc291cmNlPWdvdmRlbGl2ZXJ5IiwiYnVsbGV0aW5faWQiOiIyMDI0MDgwNS45ODYxNDI1MSJ9.22mTi3HqokhwHhibLTySCDOAlGMeD3IoggTditcGbsY/s/613002080/br/246943615582-l"><span style="mso-bookmark:gd_top">Rate
Setting page</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> of the Health PAS online portal shortly after August 9, 2024.<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Aptos",sans-serif">Adjustment of Claims with Dates of Service January 1, 2024, through August 8, 2024</span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">Providers will be responsible for adjusting claims for the above date span, as is deemed appropriate by the provider. The Department urges providers to consider the following billing guidance carefully prior to adjusting
claims. Following this guidance should prevent common billing errors that result in denials and additional edits, which ultimately delay reimbursements and may cause financial hardships.<o:p></o:p></span></p>
<ul type="disc">
<li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo3">
<span style="mso-bookmark:gd_top">For providers who submitted claims with charges
<strong><span style="font-family:"Aptos",sans-serif">at, above, or below the new rates:</span></strong> the Department recommends adjusting claims starting with the oldest dates first. <o:p></o:p></span></li></ul>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Aptos",sans-serif">Exception to the 120 Day Adjustment Timely Filing Edit:</span></strong> The Department will override the 120-day timely filing edit for all adjustments submitted for the
new COLA rate update for one year from the date of service, beginning with date of service January 1, 2024, through date of service August 8, 2024.<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Aptos",sans-serif">Adjustment Denials</span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">When an adjustment is denied, the original claim payment will be reversed, and a new claim will need to be submitted within one year from the date of service. Please ensure that adjustment denials are tracked to prevent
financial hardships.<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Aptos",sans-serif">Providers may choose to Reverse and Rebill (also called Straight Reversal) versus Adjust:</span></strong> It is important to plan for the financial impacts of reversing
claims. When claims are reversed, those payments are deducted from your current claims payments and will typically appear on the next Remittance Advice (RA) cycle. Reversed funds should be tracked and accounted for until the new claim processes and pays on
a later remittance statement. <strong><span style="font-family:"Aptos",sans-serif">Important: The reversal and new payment will not be on the same statement.</span></strong> Providers must determine the appropriate volume of claims to be reversed and consider
the timing of the reversals and new payments to prevent financial hardship. Providers must wait for the reversal claim to be in a ‘reversed’ status and appear on the remittance advice statement (RA/835), prior to submitting the new claim. Timely Filing for
reverse and rebills: Providers have one year from the date of service to submit a new claim after reversing the original. Please work the oldest dates first to avoid timely filing denials.<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Aptos",sans-serif">Processing times for Adjustments or Straight Reversals Submitted by Providers:</span></strong> Depending on the volume of claims being reviewed by the Department, providers
can expect delays in processing times as the Department will need to manually override the 120-day timely filing edits on each claim.<o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Aptos",sans-serif">Claims with Prior Authorizations (PA):</span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">The Department recommends that claims with PAs be adjusted to reduce the risk of financial hardship to the provider. To prevent denials, please first consider the number of units on the PA before submitting the adjustment.
If you prefer to reverse and rebill, please ensure the reversal has processed to a “reversed” status before the new claim is submitted to allow the units to be available for the new claim and to avoid duplicate denials. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">For additional billing guidance when adjusting or reversing claims, please see the
</span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDcsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lm1haW5lLmdvdi9kaGhzL3NpdGVzL21haW5lLmdvdi5kaGhzL2ZpbGVzL2lubGluZS1maWxlcy9SZXRybyUyMFJhdGUlMjBJbmNyZWFzZXMlMjAwNjE2MjAyMi5wZGY_dXRtX21lZGl1bT1lbWFpbCZ1dG1fc291cmNlPWdvdmRlbGl2ZXJ5IiwiYnVsbGV0aW5faWQiOiIyMDI0MDgwNS45ODYxNDI1MSJ9.x2TLVM4s11g0RjrMM4DWGCm2xU18gsbLAdGFSol82AM/s/613002080/br/246943615582-l"><span style="mso-bookmark:gd_top">How
to Adjust Claims for Retro Rate Increases (PDF) document.</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">For questions, please contact your </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDgsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lm1haW5lLmdvdi9kaGhzL3NpdGVzL21haW5lLmdvdi5kaGhzL2ZpbGVzL2lubGluZS1maWxlcy9QUlMtQXNzaWdubWVudC1MaXN0LnBkZj91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwODA1Ljk4NjE0MjUxIn0.at4t-f4oMrvHcCUN01q4idvcyomPrnDpd_RGYf9InhM/s/613002080/br/246943615582-l"><span style="mso-bookmark:gd_top">Provider
Relations Specialist</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top">.<o:p></o:p></span></p>
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