2. Institutional providers that are submitting an application to establish a new practice location must submit the applicable application fee prior to executing a MaineCare Provider Agreement. 3. MaineCare will reject the enrollment application from a newly-enrolling institutional provider, or an institutional provider who is applying to establish a new practice location, that is submitted without the application fee or documentation that CMS has granted the provider a hardship waiver for the application fee. 4. Requests for hardship waivers must be submitted to CMS pursuant to 42 CFR 424.514 D. MaineCare does not reimburse in-state providers, including rendering providers, for services provided to members prior to enrollment approval or after a provider’s enrollment has been terminated (end-dated). E. Once the enrollment application has been submitted online through the Department’s Health PAS portal, notification of MaineCare’s decision will be sent to providers via electronic notification or U.S. mail. The effective enrollment date is the effective date of the Provider Agreement. F. In the case of retroactive enrollment for Federally Qualified Health Centers (FQHCs), the retroactive FQHC enrollment will be effective on the date of the FQHC’s Health Resources and Services Administration (HRSA) or CMS approval, not before. In the case of retroactive enrollment for Rural Health Clinics (RHC), retroactive enrollment will be effective on the date of the Medicare approval. In the case of retroactive enrollment for Indian Health Centers (IHCs), the retroactive IHC enrollment will be effective on the date of the HRSA grant. G. The Department will pay for MaineCare covered services provided only to the following members: Those who are eligible for the specific services on the date the services are actually provided, unless otherwise specified in the MBM; or Those who have been granted retroactive MaineCare eligibility after services have been provided. For more information on retroactive eligibility see Section 1.04-1. H. Certain providers will be required to use rendering provider National Provider Identifier (NPI) in accordance with the appropriate billing instructions. For some of new providers not previously reimbursed under MaineCare, reimbursement rates must be established before the provider may be enrolled and reimbursed for covered services.
under the State Plan. 1.06-2 Interpreter Services A. Providers must ensure that MaineCare members are able to communicate effectively with them regarding their medical needs. MaineCare will reimburse providers for interpreters required for limited and non-English speaking members and/or deaf/hard of hearing members, when these services are necessary and reasonable to communicate effectively with members regarding health needs. Interpreter services can only be covered in conjunction with another covered MaineCare service or medically necessary follow-up visit(s) to the initial covered service. B. Family members or personal friends may be used as interpreters, but cannot be paid. "Family" means any of the following: husband or wife, natural or adoptive parent, child, or sibling, stepparent, stepchild, stepbrother or stepsister, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandparent or grandchild, spouse of grandparent or grandchild or any person sharing a common abode as part of a single family unit. Family members or friends, with the exception of those individuals under the age of 18, may be used as non-paid interpreters if: 1. requested by the member; and 2. the use of this friend or family member does not compromise the effectiveness of services or violate the member’s confidentiality; and 3. the member is advised that an interpreter is available at no charge to the member. C. If a paid interpreter is hired, providers can select the interpreter. However, should the interpreter provide transportation to the member, MaineCare will not reimburse the interpreter for transporting the member while concurrently billing for interpreter services. All interpreter services must be provided in accordance with the Americans with Disabilities Act. D. When providers request reimbursement for any interpreter services, the services must be included in the member record. Documentation must include a statement verifying the interpreter qualifications, date, time and duration of service, language used, the name of the interpreter, and the cost of performing the service. 1.06 COVERED AND NON-COVERED SERVICES (cont.) E. Providers are responsible for ensuring that interpreters protect patient confidentiality and adhere to an interpreter code of ethics. Providers shall document that interpreters have provided evidence of having read and signed a code of ethics for interpreters equivalent to the model included as Appendix #1. This shall be deemed as compliance with this requirement.