Schaller Anderson Medical Administrators, Inc. (SAMAI) is contracted with the Maine Department of Health and Human Services to provide care management services to chronically ill MaineCare members. SAMAI also provides utilization management services such as inpatient concurrent review, authorization of home health, private duty nursing for children, outpatient therapy for adults, and prior authorization of certain podiatry and out of state services.
Schaller Anderson does not pay claims, nor do we design benefits, as these are services provided solely by the Office of MaineCare Services.
Care management is available to all high-risk members, both adults and children, with the following exceptions: members who are dually eligible (receive both Medicare and Medicaid benefits); members receiving services through the HIV/AIDs waiver or comprehensive third party liability (TPL) programs. Utilization management is conducted on all eligible members based on the specific services to be reviewed.
The Maine Department of Health and Human Services has executed a contract with Schaller Anderson to provide care and utilization management services on their behalf. A component of this contractual arrangement is a Business Associate Agreement which permits Schaller Anderson to receive and transmit Protected Health Information (PHI) required as part of Treatment, Payment and Operations (TPO). However additional releases are required for information related to behavior health or substance abuse issues. Special release forms are available in such instances.
Providers, case managers and others may contact SAMAI to suggest that a particular MaineCare member is a possible candidate for the MCM benefit. SAMAI will field the request and then review the case against its eligibility criteria to make the final determination about enrollment. Factors reviewed in the determination process include the multiplicity of medical conditions, evidence of adherence to recommended treatment regimens and also to what degree the medication conditions are amenable to improvement through care management efforts. Only those patients who fit the selected enrollment criteria will be enrolled.
Enrollment in the MaineCare Care Management Benefit is on an opt-out basis. In other words, all eligible MaineCare members are considered enrolled unless they specifically request, in writing, to be disenrolled.
When your patients with MaineCare participate in the SAMAI Care Management program, you, as their provider, benefit. You will have one on one contact with the member's care manager. The SAMAI care managers can help you by supporting your patient with appointment reminders, discussions about their medications, and other self management issues. The care managers also work with members to encourage Primary Care Provider visits and reinforce the benefits of a medical home. Through the SAMAI provider web portal, you will be able to view the care management plan. Your input is always encouraged and welcome to make this the best care plan for your patient.