Resolve, Directing the Department of Health and Human Services To Amend Its Rules of Reimbursement under the MaineCare Program for Audiology and Speech-language Pathology Services

Sec. 1. MaineCare reimbursement for audiology and speech-language pathology services. Resolved: That by October 1, 2013 the Department of Health and Human Services shall amend its rules regarding audiology and speech-language pathology services under the MaineCare Benefits Manual, Chapter II and Chapter III.

1. The amended rules must reimburse all non-school-based speech and hearing pathology services provided by an independent speech-language practitioner at the rate that is paid to a speech and hearing agency for the same services.

2. The amended rules must eliminate any provision that requires prior authorization for the services of a 2nd audiologist within a 4-month time period of the provision of services by a first audiologist.

3. The amended rules must, for a person eligible for audiology services under both the federal Medicare program as the person's primary coverage and the MaineCare program as the person's secondary coverage, provide for reimbursement by the MaineCare program of the deductible applicable under the Medicare program; and be it further

Sec. 2. Rules. Resolved: That rules adopted pursuant to this resolve are routine technical rules as defined by the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A.

SUMMARY

This resolve directs the Department of Health and Human Services to amend the rules of reimbursement under the MaineCare program for audiology and speech-language pathology services by October 1, 2013 in order to equalize rates, eliminate a prior authorization requirement and provide for payment by the MaineCare program of the Medicare deductible for audiology services for certain MaineCare members. The rules are designated as routine technical rules.