ÐÏࡱá>þÿ EGþÿÿÿBCDÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Áq` ø¿ÔøbjbjqPqP qR::·ïÿÿÿÿÿÿ¤x x x x ì ì ì $ ØÉØÉØÉP(ÊDÊD Þ&”Ë”Ë4ÈËÈËÈ˧Ì·Ì ÃÌ ÞÞÞÞÞÞÞ$³ßhâì2Þì »Ó£Ì§Ì»Ó»Ó2Þx x ÈËÈËÛGÞI×I×I×»Ójx RÈËì ÈË ÞI×»Ó ÞI×I×rÝTÊ "ì pÝÈËˆË <© ËØÉ%ÔVTÝÝ|]Þ0ÞbÝã{ÖpãpÝãì pÝ ËÌþÉÎlI×5Ð$YÑbËÌËÌËÌ2Þ2ÞëÖ^ËÌËÌËÌÞ»Ó»Ó»Ó»Ó   ä_ôiä_   ôi   x x x x x x ÿÿÿÿ  TABLE OF CONTENTS PAGE 1.01 INTRODUCTION AND STATUTORY AUTHORITY 1 1.02 PROVIDER PARTICIPATION 1 1.02-1 Requirements of Provider Participation 1 1.02-2 Role of Providers, Contractors, Intermediaries in Public, Private or Voluntary Agencies, Under Provider/Supplier Agreements 5 1.02-3 Confidentiality 5 1.03 PARTICIPANT ELIGIBILITY 5 1.04 SUPPLEMENTATION BY PARTICIPANTS 6 1.05 THIRD PARTY LIABILITY 6 1.05-1 Definitions Relative to this Section 6 1.05-2 Provider/Department/Participant Responsibility 7 1.05-3 Implementing fb88 State Income Tax Refund Offset 8 1.05-4 Medicare 9 1.05-5 Procedures 10 1.06 COPAYMENT 11 1.07 SUBMISSION OF CLAIMS 12 1.07-1 Claims 12 1.07-2 Time Limit for Submission of Claims 12 1.07-3 Preparation of Claims 12 1.08 PAYMENT PROCESS 13 1.08-1 Payments 13 1.08-2 Rejected Invoices 13 1.09 CLAIM ADJUSTMENTS 13 1.09-1 Underpayments 13 1.09-2 Overpayments 14 TABLE OF CONTENTS (cont.) PAGE 1.10 INQUIRY PROCESS 15 1.10-1 Unpaid Claims 16 1.11 AUDITS 16 1.12 SANCTIONS 16 1.12-1 Grounds for Sanctioning Providers, Individuals, or Entities 16 1.12-2 Sanction Actions 18 1.12-3 Rules Governing the Imposition and Extent of Sanction 19 1.12-4 Notice of Violation 20 1.12-5 Reinstatement Procedures 21 1.13 FRAUD/ABUSE BY A PROVIDER, INDIVIDUAL OR ENTITY 21 1.13-1 Fraud 21 1.13-2 Statutory Provisions 22 1.14 PROVIDER APPEALS 23 1.14-1 General Principles 23 1.15 PARTICIPANT APPEALS 24 1.15-1 Right to Administrative Hearing 24 1.15-2 Notice of Intent to Terminate, Reduce or Suspend Eligibility or Covered Services 24 1.15-3 Procedure to Request an Administrative Hearing 26 1.15-4 Dismissal of Administrative Hearing Requests 27 1.15-5 Corrective Action 28 1.01 INTRODUCTION AND STATUTORY AUTHORITY This Section provides the overall policies and procedures for those State services administered by the Department of Human Services (“DHS” or “Department”) and incorporated by Rule in the fb88 State Services Manual. The statutory authorization for the Department to establish this rule is set forth in 22 M.R.S.A. §§ 12, 42, 3173. 1.02 PROVIDER PARTICIPATION To receive payment for medical care, services or supplies a provider must be enrolled as a fb88Care provider. To be considered for enrollment, a provider must apply by completing the appropriate forms available from the Provider File Unit, Bureau of Medical Services, Department of Human Services, 11 State House Station, Augusta, fb88 04333-0011. The provider may also access the Department web site for the necessary forms. Once the forms have been completed and returned to the Department, the provider will be notified whether enrollment is approved. For out-of-state providers, a provider who is the sole provider of a type of cost-effective medically necessary item or service may be enrolled only for the purpose of providing that item or service with prior authorization. An example would be an out-of-state laboratory, which conducts a test not provided by any in-state provider or manufacturer of a highly specialized item. The Department reserves the right to issue a request for proposals (RFP) for provision of any service or product. The Department may award a contract to an out-of-state provider. Out-of-state providers within fifteen (15) miles of the fb88/New Hampshire border and within five (5) miles of the fb88/Canada border are treated the same as fb88 providers in all aspects of policy requirements, including rates of reimbursement and payment methodologies, except that the Department will not reimburse Canadian pharmacies for non-emergency drugs to be consumed in fb88. 1.02-1 Requirements of Provider Participation Requirements for enrolled providers include but are not limited to the following: A. Utilizing the Provider Enrollment Information Form to notify the Department whenever there is a change in any of the information that the provider previously submitted to the Department. This includes servicing providers and must be done within ten (10) days of each occurrence, for example adding or deleting staff from the practice. B. Not interfering with a participant’s freedom of choice in seeking medical care from any institution, agency, pharmacy or person who is qualified to perform a required service. C. Allowing participants the freedom to reject medical care and treatment. 1.02 PROVIDER PARTICIPATION (cont.) D. Providing services and products to participants in full compliance with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the grounds of race, color, or national origin and also without discrimination on the basis of religious beliefs, sex, or handicapping conditions. E. Providing services and products to participants in the same quality and mode of delivery as they are provided to the general public. Charging and billing the Department for the provision of services and products to participants in an amount not to exceed the amount specified in the section of this Manual setting forth the benefit. G. For pharmacy providers, accepting as payment in full the fb88 Drugs for the Elderly Benefit rate for DEL covered drugs. H. Using Department designated billing forms or systems, or accepted electronic media claims (EMC) format, for submission of charges and following appropriate billing instructions. I. Maintaining and retaining financial, provider, and professional records sufficient to fully and accurately document the nature, scope and details of the health care and/or related services or products provided. Records must include, but are not limited to: all required signatures, and titles of persons providing the services, all service/product orders, verification of delivery of service/product quantity, and acquisition cost invoices where applicable. Records must be kept in chronological order with like information together, as appropriate. Such records must be retained for a period of not less than five (5) years from the date of service, or longer if necessary to meet other statutory requirements. If an audit is initiated within the required retention period, the records must be retained until the audit is completed and a settlement has been made. The provider must provide safeguards and security measures to ensure that only authorized people can enter information into electronic records or access those records. Passwords or other secure means of authorization must be used that will identify the individual and date/time of entry. Such identification will be accepted as an electronic “signature.” With security measures in place, limited access may be allowed for certain individuals for changes such as participant demographic information. There shall be a signature of record on file. 1.02 PROVIDER PARTICIPATION (cont.) J. Maintaining and retaining contracts with subcontractors for a period of at least five (5) years after the expiration date of the contract. In addition, records of contractors or subcontractors shall be subject to the same record maintenance and retention rules as are all enrolled providers. [Refer to Section 1.02-1(I)]. K. Retaining medical and provider records for a minimum of five (5) years, which include but are not limited to: 1. Identification of provider performing services billed; 2. Date of service or date materials were provided and ordered; 3. Plan of care, if applicable; 4. Service or progress notes whenever services are provided; and 5. All other essential details of the participant’s health condition and of each service provided. All entries must be signed and dated by the person providing the service, and must be legible. L. Transferring at no charge records and other pertinent information to other clinicians involved in the participant’s case, upon request and, when necessary, with the participant’s signed release of information. Participants may only be charged for copies of their own records in a manner comparable to any charges the provider may require from private pay patients. M. Complying with the Department requirements regarding faxed signatures. The Department will accept faxed (facsimile) copies of signatures as evidence of compliance with documentation requirements only when the original signature is then subsequently forwarded to the provider. 1. The provider must maintain evidence of the faxed signatures in the participant record; 2. The provider must obtain the original signed copy for the participant record within thirty (30) calendar days of the date of service. A faxed signature by itself without the original signature on record will not be acceptable proof of signature. N. Furnishing to the Department or its designee without charge, in the form and manner requested, pertinent information regarding services for which charges are made. Where appropriate as determined by the Department, this will include correspondence substantiating services or products billed by a provider, or information necessary to support requests for exemption from requirements of the Department as allowed by rule. A release of information signature is not required in order to send records to the Department or its designee. 1.02 PROVIDER PARTICIPATION (cont.) O. Holding confidential, and using for authorized program purposes only, all information regarding participants. In situations where it is medically necessary for the participant’s well being, information may be shared between providers. The rules of confidentiality apply to all providers involved as referenced in Section 1.02-3 of this Manual. Confidentiality requirements described in 22 M.R.S.A. §1711-C also apply. P. Complying with requirements of applicable Federal and State law, and with the provisions of this Manual. Q. Disclosing to the Department all financial, beneficial, ownership, equity, surety, or other interests of five per cent, (5%) or more, in any and all firms, corporations, partnerships, associations, business enterprises, joint ventures, agencies, institutions, or other legal entities providing any form of health care services or products to participants within thirty (30) calendar days of being requested by the Department to do so. R. Providing adequate access to the medically necessary covered health care services or products for which the participating provider has been approved by the Department. S. Referring to the Department any evidence demonstrating fraudulent or abusive practice, or overuse of services by providers and participants, by contacting the Bureau of Medical Services. T. Maintaining accurate and auditable financial and statistical records which are in sufficient detail to substantiate cost reports for a period of not less than three (3) years following the date of final settlement with the Department. These records of the provider shall include, but not be limited to: matters of provider ownership; organization; operation; fiscal and other record-keeping systems; Federal and State income tax information; asset acquisition; lease sale or other action; cost of ownership information on leased property even if the property is leased from an unrelated party; franchise or management arrangement; patient service charge schedule; matters pertaining to cost of operation; amounts of income received by service and purpose; and flow of funds and working capital. U. Reimbursing participants within thirty (30) days of receiving reimbursement from the Department in cases where the participant has paid for services or products. The provider must reimburse to the participant the full amount paid by the participant, less any applicable co-payment. 1.02 PROVIDER PARTICIPATION (cont.) 1.02-2 Role of Providers, Contractors, Intermediaries in Public, Private, or Voluntary Agencies Providers, contractors and intermediaries in public, private or voluntary agencies who have provider/supplier agreements with the Department, are obligated to: 1. report any suspected or identified fraud or abuse by providers or participants and submit supporting documentation to the Bureau of Medical Services; and 2. furnish available information, when requested, on excluded individuals and entities requesting reinstatement. 1.02-3 Confidentiality The disclosure of information regarding individuals receiving services under this Manual is strictly limited to purposes directly connected with the administration of those benefits. Providers shall maintain the confidentiality of information regarding these individuals in accordance with the Federal Health Insurance Portability and Accountability Act (HIPAA), and other applicable sections of State and Federal law and regulations. The Department will ensure that access to information within the control of the Department concerning participants will be restricted to persons or Department representatives who are subject to standards of confidentiality set by the Department and by federal law. Information that would tend to identify a participant may be provided only to persons or entities responsible for the administration of State services covered in this Manual. Such persons or entities shall maintain the confidentiality of all such information in compliance with applicable State and federal laws. Such information may not otherwise be released without prior written authorization from the participant or a person legally authorized to act on behalf of that participant. The Department may obtain written verification from anyone claiming to be so legally authorized. This does not prohibit the Department from releasing information to a person who needs the requested information solely to verify income, eligibility or the amount of payment related to the program benefit, provided the recipient of the information is also subject to these confidentiality provisions. Parents or guardians of minors may be required to provide annual reauthorization regarding the release of confidential information. PARTICIPANT ELIGIBILITY The Department establishes and applies written policies and procedures for taking applications and determining eligibility for assistance that are consistent with the requirements of the Benefit sought. Detailed information regarding financial eligibility standards may be obtained by contacting the Regional Offices of the Department of Human Services, or by contacting the Bureau of Family Independence regarding the applicable guidelines (Ref. Chapter 333:fb88Care Eligibility Manual) for the benefit sought. 1.03 PARTICIPANT ELIGIBILITY (cont.) A participant is defined as a person determined to be financially eligible by the Bureau of Family Independence in accordance with the financial eligibility standards established by law for that benefit and set forth in the Code of fb88 Regulations. The Department issues an eligibility card to all participants. Providers assume the risk of not being reimbursed unless they verify an individual's eligibility prior to providing services. Eligibility may be verified either through MEPOPS, by calling the Department’s Voice Response System, or other means the Department may make available. Providers who do not have access to a touch-tone telephone may contact the fb88 Information and Research Unit in the Division of Policy and Provider Services in the Bureau of Medical Services as described in Section 1.10. A participant is eligible for a benefit only if that participant meets all financial and medical eligibility criteria, and the provider satisfies applicable prior authorization requirements. 1.04 SUPPLEMENTATION BY PARTICIPANTS Providers are required to accept as payment in full the reimbursement amounts established by the Department for covered services and products. The Department will reimburse covered services or products provided to individuals who are eligible for those services or products on the date the services or products are actually provided. Providers may not request or require supplemental payments from participants other than co-payments specifically authorized by the Department. Nothing in this Section prohibits a provider from seeking payment from an individual who has knowingly misrepresented himself or herself as an applicant or participant. Enrolled providers must bill the Department for covered services or products provided to a participant during any period of eligibility for which the provider expects to be reimbursed. Nothing in this Section shall be construed as prohibiting a provider from providing free care. Each participant is eligible for as many covered services as are medically necessary within the limitations and requirements outlined in this Manual. The Department may require additional medical opinions or evaluations by appropriate professionals of its choice concerning the medical necessity or expected therapeutic benefit of any requested service. 1.05 THIRD PARTY LIABILITY 1.05-1 Definitions applicable to this Section A. Insurer is defined as: 1. any commercial insurance company offering health or casualty insurance to individuals or groups (including both experience-rated 1.05 THIRD PARTY LIABILITY (cont.) insurance contracts and indemnity contracts), or 2. any profit or nonprofit prepaid plan offering either medical services or full or partial payment for the diagnosis or treatment of any injury, disease, or disability, or 3. any organization administering health or casualty insurance plans for professional associations, unions, fraternal groups, employer-employee benefit plans, and any similar organization offering these payments or services, including self-insured and self-funded plans. B. Third Party is defined as any individual, entity, benefit or program that is or may be liable to pay all or part of the medical cost of injury, disease, or disability of an applicant or participant, excluding State services set forth in this Manual and any benefit set forth in the fb88Care Benefits Manual. 1.05-2 Provider/Department/Participant Responsibility For each State service set forth in the State Benefits Manual, the Department shall be the payor of last resort. The Department will not reimburse any amounts which otherwise would be reimbursed by any insurer or third party. It is the responsibility of the provider to make a reasonably thorough effort to identify, and obtain reimbursement from, any insurer or third party that may be a source of reimbursement. For all questions involving the determination of coverage by a third party insurer, the provider may directly contact the Bureau of Medical Services, Third Party Liability Unit to verify health insurance information. Payment by a primary HMO to non-participating providers does not obligate the Department to pay as a secondary payor. This applies even if the primary HMO authorizes the service. If the provider will not be eligible to receive reimbursement from the Department as a result of failing to participate in the participant’s plan prior to the provision of services, the participant must be notified in writing that he or she will be billed. In cases where third party payment responsibility is questionable or unavailable, providers may bill the Department for covered services but must do so within the time provided in Subsection 1.07. The Department will take reasonable measures to ascertain any legal liability of third parties for services rendered to participants, the need for which arises out of injury, disease or disability. With the exception of those services described in this Sub-Section, the Department will not reimburse for services or products previously denied in part or in full by a liable third party payor (including 1.05 THIRD PARTY LIABILITY (cont.) Medicare), if denied because the services or products were not covered or the provider was not authorized under that plan. The Department will not reimburse providers for discounts or billing adjustments provided to third party payors in connection with services or products provided to a participant. The Department will not reimburse providers for any reduction (in part or full) in reimbursement imposed by a third party payor as a result of the absence of a referral, the failure to obtain prior authorization, or geographic limitations established by the third party payor. The Department will not reimburse a provider who did not accept assignment and/or was not enrolled in a plan that otherwise would have provided reimbursement. The Department may be responsible for payment of a deductible or coinsurance required by such a plan, for appropriately obtained services also covered under fb88 State funded services. Such payments shall be limited to the maximum amount designated by the Department for covered services, in accordance with Section 1.05-5(B). Further details are included in the applicable Section of this Manual. The Department will seek reimbursement from a third party when that party's liability is established after the Department has reimbursed the provider and in any other case in which the liability of a third party existed but was not treated as a resource. 1.05-3 Implementing fb88 State Income Tax Refund Offset The Department may apply to the fb88 State Tax Assessor for a State income tax refund offset to recover money that is due the Department from a provider, participant or other person. A. Liquidated Debt For purposes of implementing a fb88 State Income Tax Refund Offset, the Department shall serve notice on the provider, participant or other person alleging the debt and informing the provider, participant or other person of the right to an Administrative Hearing pursuant to the fb88 Administrative Hearing Regulations. 1.05 THIRD PARTY LIABILITY (cont.) B. Administrative Hearing - Liquidated Debt If an administrative hearing is requested within thirty (30) calendar days of the date notice was served, a hearing shall be held pursuant to the fb88 Administrative Hearings Regulations. In determining if a debt is liquidated, the hearing shall be limited to the issues of whether the money is due the Department by the alleged debtor and whether any post liquidation events have affected the debt. If the debt is affirmed following a hearing, the debt shall be deemed liquidated immediately upon expiration of any appeal deadline. If the debtor files an appeal, the debt shall be deemed liquidated immediately upon any final decision affirming the outcome of the hearing. If the individual or entity fails to request a hearing within thirty (30) calendar days of the date of the notice alleging the debt, the individual or entity is deemed to have forfeited the right to an Administrative Hearing, and waived any objection he or she may have to this debt being liquidated. C. Notification of State Tax Assessor The Department shall notify the State Tax Assessor annually of all individuals or entities who owe a liquidated debt to the Department that is greater than $25.00. D. Changes to the Notification The Department shall notify the State Tax Assessor of any decrease in or elimination of debt which has been collected through the State Income Tax Refund Offset. E. Finalization of Offset The Department must release to the taxpayer any offset refund amount determined after hearing not to be a liquidated debt due to the agency, within ninety (90) calendar days of such determination. 1.05-4 Medicare Medicare beneficiaries are eligible for the benefits established in the State Benefits Manual, with the limitations and exceptions set forth herein. 1.05 THIRD PARTY LIABILITY (cont.) 1.05-5 Procedures A. All providers: 1. Must identify third party resources and total third party payments on applicable claim forms. 2. Must seek information about third party resources from the participant and allow ninety (90) calendar days for the participant to cooperate in providing information about third party resources. If after ninety (90) calendar days the participant or policyholder has failed to cooperate in providing such information as set forth below, the provider may then follow the billing instructions established by the Department. Cooperative participants are those who: a. provide necessary third party insurance information to providers when requested to do so; b. provide signatures required to process third party claims; and c. have been reimbursed by a third party and have then reimbursed the provider for the services for which they received the reimbursement. 3. Must be able to show evidence of third party resource responses (explanation of benefits, including explanation of the basis for denials, and related information) prior to billing the Department for covered services. Claims that include such evidence may only be billed to the Department according to the appropriate billing instructions. 4. May bill the Department without having received payment or denial notice from the third party in cases where the policyholder is an absent parent of a participant, but only after the provider has billed the third party and received no response within thirty (30) calendar days. When billing the Department under this subsection, the provider must sign and submit to the Department a certification as follows: I certify that I have submitted the attached claim to _______________________(health insurance company name). I have waited thirty (30) calendar days. I have received no response. 1.05 THIRD PARTY LIABILITY (cont.) I understand the Department will audit provider compliance with these certification requirements. _____________________________ (Signature) _____________________________ (date) 5. Must include the following statement on any bill or copy of a bill provided to any person or entity in connection with covered services or products provided to the participant: "This Patient’s Benefits Are Assigned to the State of fb88 by Law." B. Balance Billing After Third Party Payment Providers must follow the following procedures when billing the Department following receipt of third party payment: 1. Fee-for-Service Claims a. The total bill may not exceed the allowed amount as set forth in the Explanation of Benefits (EOB) published by that insurer. b. The third party amount must equal the actual third party payment plus any withheld amount as indicated on the insurance company Explanation of Benefits. 2. Capitated Services Capitated services are services covered under the capitation agreement between a managed care plan and the participant’s provider. For capitated services, the provider may only bill the Department for the amount of the participant’s copayment for that service. 1.06 COPAYMENT A copayment may be charged to participants for each service or product provided as a benefit. The amount of the copayment shall be as specified in the Section covering the specific benefit provided. A provider may require any participant to pay the co-payment, if any, established under the applicable benefit. A provider may not request or require any payment or co-payment in excess of that authorized under the applicable benefit. If a participant disputes the amount of the copayment, he or she may contact the Department for assistance in resolving that dispute. Complaints should be directed to 1.06 COPAYMENT (cont.) the Assistant Director, Bureau of Medical Services, 11 State House Station, Augusta, fb88 04333-0011. 1.07 SUBMISSION OF CLAIMS 1.07-1 Claims Claims for reimbursement must be submitted in either paper or electronic format in accordance with the Department’s billing instructions. 1.07-2 Time Limit for Submission of Claims The provider must submit a claim for reimbursement within one (1) year of the date services are provided, regardless of when eligibility is verified. Since it is the responsibility of the provider to verify eligibility, participants may not be billed for covered services that have been denied by the Department for exceeding the one (1) year limit for claims submission as described in this Section because the provider did not verify eligibility. If a service or product is provided after the effective date of eligibility but before the Department has made an eligibility determination, the provider has one (1) year to submit a claim to the Department from the date that the participant was determined to be eligible. Claims submitted for services or products involving cost-based reimbursement must reflect dates of service based upon days actually billed in only one of the provider’s fiscal years. In the event a claim for services or products extends from one fiscal year to the next, a separate claim must be submitted for each of the fiscal years as different cost-based reimbursement rates likely may apply. When claims are rejected, providers have one (1) year from the date of the initial submission of the claim to resubmit a correct claim for payment to resolve the claim. The one (1) year limit for resubmission applies to all rejected claims except in cases involving other insurance carriers or Workers’ Compensation, in which cases the one (1) year limit applies from the date on the carrier’s explanation of benefits. 1.07-3 Preparation of Claims A. Original Paper Claims All paper claims must be accurate, complete and legible. Only typed original claims or computer generated original claims with information clearly entered within the required information fields are acceptable for processing. All attachments must be eight and one-half by eleven (8½x11) paper. Providers must follow billing instructions issued by the 1.07 SUBMISSION OF CLAIMS (cont.) Department. Any mistakes or omissions by the provider may substantially delay processing. All claims must be signed and dated by the provider, an authorized employee, a computer generated authorization method, or by means of a stamped signature. The provider must assume full responsibility for the accuracy of the claim regardless of who completes, signs and submits the claim forms. Any claim lacking clear authorization will be rejected without payment as set forth in 1.08-2. B. Preparation of Electronic Media Claim Transmissions Providers who have entered into an Electronic Media Claims (EMC) Provider/Supplier Agreement with the Department must follow the billing instructions contained in their EMC enrollment package. Information regarding submission of claims over the web will be available to providers upon implementation of the fb88 Claims Management System, (MECMS). 1.08 PAYMENT PROCESS 1.08-1 Payments The Office of the State Treasurer issues all payments. A Remittance Advice (RA) is sent with each payment showing payment or denial of specific claims. 1.08-2 Rejected Invoices The Department does not make reimbursement for any claim rejected due to invalid or incomplete information. Each rejected claim will be set forth on the Remittance Advice with a notation of the reason for the rejection. The Department will process a corrected claim only if resubmitted within the time limits provided in Section 1.07-2. If the provider believes that payment was erroneously denied, or that the reimbursement amount was incorrect due to a billing or processing error, the provider must follow the billing instructions issued by the Department. 1.09 CLAIM ADJUSTMENTS 1.09-1 Underpayments When the Department determines, as the result of an audit, that an underpayment has been made to a provider, the Department will send notification and authorization for billing to the provider. If a provider believes an underpayment has been received for covered services rendered, based upon 1.09 CLAIM ADJUSTMENTS (cont.) policy and procedures as described in this Manual, the provider may accept and cash the check issued for the services provided without waiving the right to seek the balance of the correct amount due. A provider who believes an underpayment has occurred must comply with the most current billing instructions as issued by the Department. 1.09-2 Overpayments If the Department determines, as a result of an audit, review, or other information, that a provider has received payment in excess of the correct reimbursement amount, or that no reimbursement should have been paid, the following provisions apply: A. When the Department determines that an overpayment has been made it will notify the provider in writing of the nature of the overpayment, the method of computing the dollar amount to be refunded, and of any further action. Failure to reimburse the Department as set forth in this subsection may result in provider sanctions as described in Section 1.12. The Department or its agent may recover overpayments by direct reimbursement, offset, civil action or other means authorized by law. The Department may also collect interest on overpayments as provided in 22 M.R.S.A. § 1714-A. 1. Direct Reimbursement Unless other regulations apply, the provider must directly reimburse the Department within thirty (30) calendar days of the date of the notice of the overpayment. 2. Offset If thirty (30) calendar days have elapsed since the provider was given notice of the overpayment, the Department may withhold payment on pending claims and on subsequently received claims for the amount of the overpayment that the provider has not directly reimbursed. 3. Civil Action The Department may file a civil action in the appropriate Court and exercise all other civil remedies available to the Department in order to recover the amount of an overpayment. 1.09 CLAIM ADJUSTMENTS (cont.) 4. Lien and Foreclosure Pursuant to 22 M.R.S.A. §1714-A the Department may recover the amount of an overpayment through lien and foreclosure thirty-one (31) calendar days after exhaustion of all administrative appeals and any judicial reviews under 5 M.R.S.A. §8001 et. seq. B. When a provider determines that an overpayment has been made, the provider shall comply with the most recent billing instructions as issued by the Department. 1.10 INQUIRY PROCESS The Voice Response System is available to providers to check participant eligibility, status of claims, third party payment insurance, and eligibility This system is available twenty-four (24) hours a day, seven (7) days a week and allows unlimited inquiries for each call. The provider must give the provider ID number, member name and date of birth, or either the member ID number or Social Security Number before the Voice Response System will provide any information. The Department requests that providers use the Voice Response System, or other automated means made available by the Department, prior to calling the Information & Research Unit. When a provider is in need of an immediate resolution to a policy and/or procedural question, the Provider Relations Unit in the Division of Policy and Provider Services may be contacted by telephone, or by submitting an e-mail inquiry by consulting the current list of telephone numbers and e-mail addresses provided by the Department. Written inquiries regarding the payment or nonpayment of claims should be mailed to: Inquiry Unit Division of Policy and Provider Services Bureau of Medical Services 11 State House Station Augusta, fb88 04333-0011 1.10 INQUIRY PROCESS (cont.) Inquiries should be accompanied by copies of any documents that would be of assistance in resolving the inquiry. Priority will be given to written inquiries that contain copies of claims, Remittance Advices and any other pertinent documents. 1.10-1 Unpaid Claims When a provider submits a claim and has not received a response from the Department within ninety (90) calendar days, the provider should attempt to ascertain the status of the claim through the Voice Response System before rebilling. The Voice Response System will let the provider know if the claim has been paid or denied and on what date. If the Voice Response System indicates that the Department has no information on file, the claim should be resubmitted. 1.11 AUDITS The Department or designee may audit payments to any provider or conduct a post-payment review. 1.12 SANCTIONS 1.12-1 Grounds for Sanctioning Providers, Individuals or Entities Sanctions may be imposed by the Department against a provider, individual, or entity for any one or more of the following reasons: A. Presenting or causing to be presented for payment any false or fraudulent claim for services or merchandise; B. Submitting or causing to be submitted false information for the purpose of obtaining greater compensation than that to which the provider is legally entitled; C. Submitting or causing to be submitted false information for the purpose of meeting prior authorization requirements; D. Failing to retain or disclose or make available to the Department or its authorized agent records of services provided to participants and related records of payments; E. Failing to provide and maintain quality services within accepted professional or program standards as judged by peer reviewers; F. Engaging in a course of conduct or performing an abusive act incompatible with serving as a provider following notification that said conduct should cease. 1.12 SANCTIONS (cont.) Examples of such abusive acts include, but are not limited to, the following: 1. Furnishing services or supplies which are determined by the Department to be substantially in excess of the needs of, or harmful to, individuals, or to be of inferior quality, or not of usual or customary quality; 2. Soliciting or accepting from a participant, his or her family, friend or other representative an amount over and above the reasonable charge amount, co-payment, or fee schedule established for covered services (supplementation); 3. Maintaining a separate schedule of charges for participants that results in higher charges for participants than for non-participants ; G. Breaching the Requirements of Section 1.02-1 for provider participation; H. Over utilizing a Benefit by inducing, furnishing, or otherwise causing a participant to receive medically unnecessary service(s) or products ; I. Rebating or accepting a fee or portion of a fee or charge for a participant referral (kickback); J. Violating any law governing benefits included in this Manual, or any rule or regulation promulgated pursuant thereto; K. Submission of a false or fraudulent application for provider status; L. Violation of any laws, regulations or code of ethics governing the conduct of occupations or professions or regulated industries; M. Conviction of a criminal offense relating to performance of a Provider/Supplier Agreement with the State, negligent practice resulting in death or injury to patients, or misuse or misapplication of benefit or service funds; N. Failure to meet standards required by State or Federal law for participation (e.g. licensure or certification requirements); O. Charging participants for services over and above the amount allowed by the Department; 1.12 SANCTIONS (cont.) P. Failure to correct deficiencies in provider operations in accordance with an accepted plan of correction after receiving written notice of these deficiencies from the Department; Q. Formal reprimand or censure by an association of the provider's peers for unethical practices; R. Suspension, exclusion or termination from participation in another governmental medical program, such as fb88Care, Medicare, Workers’ Compensation, Children With Special Health Needs Program, and Rehabilitation Services, for fraudulent or abusive practices; S. Indictment for fraudulent billing practices, negligent practice, or patient abuse; T. Failure to repay or make arrangements for the repayment of overpayments; U. Failure to return money paid by participants for covered services or products provided during any period in which the participant was determined to be retroactively eligible when there is evidence that the provider received notification of retroactive eligibility; or V. Breach of the terms of legal and binding contract(s) with contractor(s) or subcontractor(s) who provide their contractual services to participants. 1.12-2 Sanction Actions The following sanctions may be imposed on providers, individuals or entities based on the grounds specified in Section 1.12-1 A. Termination from participation in any applicable Benefit; B. Suspension of participation in any applicable Benefit; C. Suspension, withholding, or recoupment of Benefit reimbursement; D. Required attendance at provider education sessions; E. Prior authorization of services; F. One-hundred percent (100%) review of the provider's claims prior to payment; G. Forfeiture of any payment for services, supplies or goods, associated with grounds for sanctioned providers. 1.12 SANCTIONS (cont.) 1.12-3 Rules Governing the Imposition and Extent of Sanction A. Imposition of Sanction The decision to impose a sanction shall be the responsibility of the Commissioner of the Department of Human Services, who may delegate sanction responsibilities to the Director of the Bureau of Medical Services or a designated staff person of the Bureau of Medical Services. 1. The following factors shall be considered in determining the sanction(s) to be imposed: (a) Seriousness of the offense(s); (b) Extent of violation(s); (c) History of prior violation(s); (d) Prior imposition of sanction(s); (e) Prior provision of provider education; (f) Provider willingness to obey Benefit rules; (g) Whether a lesser sanction will be sufficient to remedy the problem; and (h) Actions taken or recommended by peer review groups, other payors, or licensing boards. 2. Where a provider, individual or entity, has been convicted of defrauding a Benefit, or has been previously suspended or terminated from any Program, including Medicare, for abuse, the Department shall institute proceedings to terminate participation of the provider, individual or entity from all Benefits set forth in the State Benefits Manual. B. Scope of Sanction 1. A sanction may be applied to a provider, individual, or entity, or to all known affiliates of a provider, provided that each decision to include an affiliate is made on a case-by-case basis after giving due regard to all relevant facts and circumstances. 2. Suspension or termination from participation of any provider, individual or entity shall preclude such provider from submitting claims for payment, either personally or through claims submitted by any clinic, group, corporation or other association to the Department or its fiscal agents for any services or products except for those services or products provided prior to the suspension or termination. 1.12 SANCTIONS (cont.) 3. No clinic, group, corporation or other association which is a provider of services shall submit claims for payment to the Department or its fiscal agents for any services or products provided by a person within such organization who has been suspended or terminated from participation in any Benefit in the State Benefits Manual except for those services or products provided prior to the suspension or termination. 4. When a sanction is imposed under this subsection by a provider that is a clinic, group, corporation or other association, the Department may suspend or terminate such organization and/or any individual person within said organization who is responsible for such violation and administer other sanctions. C. Notice of Sanction 1. When a provider, individual or entity, has been sanctioned, the Department shall notify, if appropriate, the applicable professional society, Board of Registration or Licensure, his or her employer, and Federal or State agencies of the findings made and the sanctions imposed. 2. Once a provider, individual or entity’s participation in a Benefit covered in the State Benefits Manual has been suspended or terminated, the provider must notify all affected Benefit participants within thirty (30) days that the provider, individual or entity, has been suspended or terminated and must arrange orderly transfer of records to other providers as applicable. 1.12-4 Notice of Violation If the Department has information that indicates that a provider may have submitted bills and/or has been practicing in a manner inconsistent with the program requirements, and/or may have received payment for which he or she may not be properly entitled, the Department shall so notify the provider . The written notification shall be sent to the provider and shall allow at least thirty-one (31) calendar days from the date of the notice before the effective date of any further action or imposition of sanction, unless the information received by the Department indicates a danger to the life and/or safety of any participant, in which case notice may be provided simultaneously with the further action or sanction. The notice shall set forth: A. The nature of the discrepancies or violations; B. The dollar value of such discrepancies or violations; 1.12 SANCTIONS (cont.) C. The method of computing such dollar value, including any of the following: 1. extrapolation from a systematic random sampling of records, 2. a calculation from a selective sample of records, or 3. a total review of records. D. Any further actions to be taken or sanctions to be imposed by the Department; and E. Any actions required of the provider, and the right to request an informal review and administrative hearing, as set forth in Section 1.14. An adverse decision may be appealed pursuant to the procedures outlined in Section 1.14. A request for review of proceedings thereunder does not stay the sanction imposed by the Department. 1.12-5 Reinstatement Procedures A request for reinstatement must be addressed to the Director of the Bureau of Medical Services. After the provider submits a completed enrollment form, a decision regarding reinstatement will be made. Any sanctions, including outstanding monetary sanctions, will be a factor in determining whether or not a provider will be considered for reinstatement in any Benefit set forth in the fb88 State Services Manual. The Department will review any request for reinstatement after considering any decisions or actions made by the United States Department of Health and Human Services, past actions in state or federal benefits, and other relevant factors such as professional sanctions. 1.13 FRAUD/ABUSE BY A PROVIDER, INDIVIDUAL OR ENTITY 1.13-1 Fraud A. Fraud includes intentional deception or misrepresentation, oral or written, which an individual knows to be false, or does not believe to be true, made with knowledge that deception or misrepresentation could result in some unauthorized benefits. The requisite intent is present if the misrepresentation was made knowingly or with a reckless disregard for the truth. B. Examples of conduct which could constitute fraud include, but are not limited to, the following: 1. Billings for services, products, supplies, or equipment that were not rendered to, or used for, participants in State Benefits; 1.13 FRAUD/ABUSE BY A PROVIDER, INDIVIDUAL OR ENTITY (cont.) 2. Billings for supplies or equipment that are clearly unsuitable for the participant’s needs or are so lacking in quality or sufficiency for the purpose as to be virtually worthless; 3. Flagrant and persistent over utilization of medical or paramedical services with little or no regard for results, the participant’s ailments, condition, medical needs, or the provider’s orders; 4. Claiming of costs for non-covered or non-chargeable services, supplies or equipment disguised as covered items; 5. Material misrepresentations of dates and descriptions of services rendered, or of the identity of the participant or the individual who rendered the services; 6. Duplicate billing which appears to be deliberate. This includes billing twice for the same service; billing both the State Benefit, a third party insurer, and/or the participant for the same services; billing for the same service under different codes or different policies; and/or billing for the same service under different provider numbers; 7. Arrangements by providers with employees, independent contractors, suppliers, and others that appear to be designed primarily to overcharge the Department with various devices (commissions, fee splitting) used to siphon off or conceal profits; 8. Charging to the Department costs not incurred or which were attributable to non-program activities, other enterprises, or personal expenses of principals; 9. Deliberately providing, or receiving medical services on the account of another individual; 10. Deliberately billing participants rather than the Department for covered services; 11. Concealing business activities that would prevent compliance with applicable requirements; 12. Falsifying provider records in order to meet or continue to meet the conditions of participation; and 13. Soliciting, offering, or receiving a kickback, bribe, or rebate. 1.13-2 Statutory Provisions A. Provider claims for payment from any Benefit in the State Benefits Manual are subject to fb88 criminal and/or civil fraud Statutes, including the following: 1. 17-A M.R.S.A. §354, Theft by Deception, makes it a crime to obtain or exercise control over property of another as a result of deception, and with an intention to deprive a person thereof. 1.13 FRAUD/ABUSE BY A PROVIDER, INDIVIDUAL OR ENTITY (cont.) 17-A M.R.S.A. §453, Unsworn Falsification, makes it a crime if a person makes a written false statement which he or she does not believe to be true, on or pursuant to, a form conspicuously bearing notification authorized by Statute or Regulation to the effect that false statements made therein are punishable; or with the intent to deceive a public servant in the performance of his or her official duties, he or she makes any written false statement which he or she does not believe to be true; or knowingly creates, or attempts to create a false impression in a written application for any pecuniary or other benefit by omitting information necessary to prevent statements therein from being misleading and is punishable as a Class D crime. 17-A M.R.S.A. §151, the Conspiracy Statute, makes it a crime if, with the intent that conduct be performed which, if fact, would constitute a crime or crimes, a person agrees with one or more others to engage in or cause the performance of such conduct. 22 M.R.S.A. §15, fb88’s false claims act, imposes restitution and treble penalties on anyone who defrauds the Department by obtaining payment for any false, fictitious or fraudulent claim. 1.14 PROVIDER APPEALS 1.14-1 General Principles Any provider who is aggrieved by an action made pursuant to this Manual has thirty (30) calendar days from the date of receipt of that decision, to request an informal review, in writing, to the Director of the Bureau of Medical Services. This review will be conducted by the Director of the Bureau, or a designee who was not involved in the decision under review. Issues not raised by the provider, individual, or entity at the informal review are waived in subsequent appeal proceedings. Requests for informal reviews shall be submitted to the Bureau of Medical Services. A written report of the decision resulting from that review will be issued to the provider. The Department will not continue payment of claims beyond the date of the decision if the decision is in favor of the Department, regardless of whether a judicial review is requested. The Department shall not be obligated to stay its action against a provider during the appeal process. 1.14 PROVIDER APPEALS (cont.) A provider must request an informal review and obtain a decision before requesting an administrative hearing. If the provider is dissatisfied with the informal review decision, he or she may write the Commissioner of the Department of Human Services to request a hearing provided he/she does so within thirty (30) calendar days of the date of the Director's report on the Department’s action. Subsequent appeal proceedings will be limited only to those issues raised during the informal review. The Office of Administrative Hearings shall notify the provider in writing of the date, time and place of the hearing, and shall designate a presiding officer. Providers will be given at least twenty (20) calendar days advance notice of the hearing date. The hearing shall be held in conformity with the fb88 Administrative Procedures Act, 5 M.R.S.A. §8001 et seq. and the Administrative Hearings Regulations. The presiding officer shall issue a written decision and findings of fact to the provider or, pursuant to provisions of the Administrative Hearings Regulations, issue a written recommendation to the Commissioner of Human Services who will make the final decision. Providers may be represented by legal counsel at a hearing, and may request or subpoena persons to appear at the hearing where they can be expected to present testimony or documents relating to issues at the hearing, in accordance with the Administrative Hearing Rules. If the provider is dissatisfied with the final decision, an appeal may be taken to the Superior Court pursuant to the Administrative Procedures Act. 1.15 PARTICIPANT APPEALS 1.15-1 Right to Administrative Hearing The Department will provide a hearing to: A. Any participant who requests a hearing on the basis of the Department’s denial of services or products or failure to act upon a request for services or products with reasonable promptness; and B. Any participant who requests a hearing upon belief that the Department has erroneously terminated, reduced, or suspended medical or financial eligibility or covered services. 1.15-2 Notice of Intent to Terminate, Reduce or Suspend Eligibility or Covered Services A. Notice must be mailed or delivered in person to the participant when there has been a termination, suspension or reduction of eligibility for any Benefit as set forth below. 1.15 PARTICIPANT APPEALS (cont.) Specific information that must be included in these notices include: 1. A statement of the intended action; 2. An explanation of the reasons for the action, as well as a specific citation to the underlying State or Federal regulations that support the action; 3. A statement that the participant has a right to a hearing; 4. An explanation of the procedures for obtaining a hearing; 5. A statement that a participant may be represented by legal counsel, relatives, friends or a spokesperson and a list of selected legal service providers available to assist the participant in arranging for legal counsel; 6. The name and telephone number of the person who should be contacted, should the participant have questions regarding the notice; and 7. An explanation of the circumstances under which medical eligibility and/or covered services are continued if a hearing is requested. B. Advance notice must be mailed or delivered in person to a participant at least ten (10) business days before an action to terminate, suspend, or reduce services becomes effective. Computation of time shall be as defined in the Administrative Hearings Regulations. A participant is presumed to have been provided a notice if there is evidence that the notice was timely placed in the mail system or delivered in person. The advance notice requirement applies unless: 1. the Department has facts indicating a substantial probability of fraud, in which case advance notice of five (5) calendar days is required; 2. the Department has factual information confirming the death of a participant; 3. the agency receives a clear written statement, signed by the participant, that the participant no longer wishes services; or gives information that requires termination or reduction of services and indicates that the participant understands that this termination or reduction is the result of giving that information. 4. the participant has been admitted to an institution where he or she is ineligible for further services; 5. the participant’s whereabouts are unknown, and the post office returns agency mail directed to him or her indicating no forwarding address; or 1.15 PARTICIPANT APPEALS (cont.) 6. the participant has been accepted for services by another local jurisdiction, State or territory that render the participant ineligible for benefits under the State Benefit. 1.15-3 Procedure to Request an Administrative Hearing A participant may request an administrative hearing if he or she is aggrieved by any Departmental action that may terminate, reduce, or suspend services under a State Benefit. The Department may respond to a series of related requests for a hearing by conducting a single group hearing. Participants must follow the procedures described in this Section when requesting an administrative hearing. A. An administrative hearing may be requested by a participant or his/her authorized representative. B. Unless otherwise specified in this Manual, a request for an administrative hearings must be received within sixty (60) calendar days of the date of written notification to the participant of the action the participant wishes to appeal. C. Unless otherwise specified in this Manual, the request must be made by the participant or his or her representative, in writing or verbally, to Member Services at P.O. Box 709, Augusta, ME 04332, phone (800) 977-6740, or TTY (800) 977-6741, for a hearing with the Office of Administrative Hearings, Department of Human Services. For the purposes of determining when a hearing was requested, the date of the hearing request shall be the date on which the request for a hearing is received by Member Services. The date a verbal request for an administrative hearing is made is considered the date of request for the hearing. Member Services may also request that a verbal request for an administrative hearing be followed up in writing, but may not delay or deny a request on the basis that a written follow-up has not been received. Member Services shall send a fax or copy of all hearing requests to the Assistant Director of the Bureau of Medical Services, and to the Office of Administrative Hearings, within twenty-four (24) hours of receiving the request. D. The hearing will be held in conformity with the fb88 Administrative Procedures Act, 5 M.R.S.A. §8001 et. seq. and the Department's Administrative Hearings Regulations. E. The hearing will be conducted at a time, date and place convenient to the parties and at the discretion of the Office of Administrative Hearings, and at least twenty (20) calendar days prior notice of the hearing will be given. In scheduling a hearing, there may be instances where the hearing officer shall schedule the hearing at a location near the participant or by telephone or interactive television system. 1.15 PARTICIPANT APPEALS (cont.) F. The Department and the participant may be represented by others, including legal counsel, and may call witnesses on their behalf. G. The hearing will be conducted by an impartial official. H. The hearing officer on his or her own motion or at the request of either Department representatives or the participant may request or subpoena one or more persons to appear where that person can be expected to present testimony or documents relating to the issues at the hearing. The cost of the subpoena shall be borne by the Department. J. When the participant or the Department or an authorized agent of the Department requests a delay, the hearing officer may reschedule the hearing, after notice to both parties. Decisions rendered by the hearing authority in the name of the fb88 Department of Human Services will be binding upon the Department, unless the Commissioner directs the hearing officer to make a proposed decision reserving final decision-making authorization to the Commissioner. L. Any person who is dissatisfied with the hearing authority's decision has the right to judicial review under fb88 Rules of Civil Procedure, Rule 80C. 1.15-4 Dismissal of Administrative Hearing Requests A. If any of the following circumstances exist, the Office of Administrative Hearings may dismiss the request for an administrative hearing. This dismissal is the final agency action on the matter. 1. The participant withdraws the request for a hearing. 2. The participant, without good cause, fails to appear at the hearing. 3. The sole issue being appealed is one of Federal or State law requiring an automatic change adversely affecting some or all participants. B. Where an applicant's or participant’s request for an administrative hearing is dismissed pursuant to this Section, the Office of Administrative Hearings shall notify the participant of his/her right to appeal that decision in Superior Court. 1.15 PARTICIPANT APPEALS (cont.) 1.15-5 Corrective Action The Department must promptly make any applicable corrective payments, when appropriate, retroactive to the date an incorrect action was taken by the Department, if: A. The hearing decision is favorable to the applicant or participant; or B. The agency decides in the applicant or participant’s favor before the hearing.     10-144 Chapter 104 MAINE STATE SERVICES MANUAL SECTION 1 ADMINISTRATIVE POLICIES AND PROCEDURES Effective 9/29/2003 PAGE  PAGE i  PAGE 2 John Elias Baldacci Governor State of fb88 DEPARTMENT OF HUMAN SERVICES Augusta, fb88 04333  ALb@ W b ‹   x ‹ Ÿ  T e Â Ñ õ û   ý , f v Ÿ ² ÑáâõJ`(>Ž"¤" ,,c14©5¿5h7j7¶:;?;D;^;¹;Ù;<Ÿ<®=Í=³>´>Ì>Õ@ì@ñDEJJ!J7J K#K)U?U]*]àb¨cúöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöñöéöñöäöÛÒÛÒÛÒÛÒÛÒÛöñöñöñöéöñöñöñöñöÈhÑ9l>*‰ÊhÑ9l‰Êæ’w¦hÑ9l‰Ê hÑ9l7hÑ9lB*ph hÑ9l5hÑ9l hÑ9l>*OFGgh™æ : ; \ ] … † ¥ úúôæàæÞиÐÞæÞæÞ¦$ Æ !„Є0ý1$^„Ð`„0ýa$ Æ !„ ^„  Æ !„ „0ý^„ `„0ý Æ !„ „0ý^„ `„0ý Æ ! 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