MaineCare doesn't have liberal eligibility and people don't move in and out of the state based upon benefits supplied by the program, but it covers a high percentage of Maine's over-65 population.
That's the viewpoint of Anthony Marple, director for the Office of MaineCare Services, who spoke at the Maine Chapter of Healthcare Financial Management Association's 50th annual meeting this past week in Bar Harbor, Me.
According to the HFMA, 52 percent of insurance in Maine is covered by employers, while 4 percent is covered individually, 20 percent is covered by Medcaid and 12 percent is covered by by MaineCare.
Marple's MaineCare update presentation showed that spending on MaineCare topped out at $2.3 million in 2008, and Medicaid spent $7,586 per member in 2004. In 2008, the growth in spending was -2.2 percent. Also, expenditures in SFY 2007 cost $2.1 billion. Administrative costs, as a percent of spending, were -3.8 percent for MaineCare in SFY 2007 and -8.8 percent for Medicare in 2006.
Looking ahead, the 2009 Office of MaineCare Services' (OMS) new budget initiatives include $23 million for behavioral managed care, $81 million for clinical care management, $46 million for third party liability and $6 million for pharmacy-for-brand limit.
The MaineCare Supplemental 2009 budget initiatives include a hospital tax and match program worth $7 million and PNMI bed hold payments valued at $12 million.
"Programs should expect another $100 million in cuts next year," said Marple.
A MaineCare/Medicare crossover project is in the works and the Unysis crossover functionality should be up and running by February of 2010, said Marple. Slides showed that hospitals would receive two reports: Qualified Medicare beneficiaries (QMB) and non-QMB. There will be a QMB crossover, too.
Other hospital initiatives presented at the HFMA meeting include:
• Credit balances that require a 60-day turnaround;
• Perform error rate measurement (PERM) for medical record data with a 30-day turnaround; and
• NDC codes using a roster method.
Marple said that decisions to be made of on APC would include weather they'd be hospital-specific or standardized, PIP per claim and what the timing on the project would be.
MaineCare physician fees for FY09 are estimated to increase 9.4 percent overall, according to the OMS, with a $4.9 million fee table and $1.4 million more in primary care management.
"We want to improve health status in the future," said Marple.
Will any of the initiatives affect your practice? How do the numbers compare to other states? Send your comments to Associate Editor Chelsey Ledue at chelsey.ledue@medtechpublishing.com.