MaineCare Notice of Agency Waiver Amendment
AGENCY: Department of Health and Human Services, Office of MaineCare Services
RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Section 113, Non-Emergency Transportation Waiver
MaineCare Rate Reform Technical Advisory Panel (TAP) Meeting and Public Stakeholder Forum on Draft Rate Determination Schedule
P.L. 2022, Ch.639 codifies into statute the principles and processes by which MaineCare sets its rates. Pursuant to Ch. 639, the Department must:
Re-Opening of PCPlus Application
MaineCare Services is pleased to announce that beginning October 7, 2022, we will again accept applications for participation in MaineCare’s Primary Care Plus (PCPlus) program. PCPlus is a MaineCare primary care model that gives Primary Care Providers (PCPs) greater flexibility and incentives to meet MaineCare members’ healthcare needs. MaineCare is transitioning away from a volume-based (fee-for-service) payment system toward population-based payments tied to cost and quality-related outcomes.
Atrezzo Upgrade
On Monday, November 7, 2022, Kepro will upgrade their web-based platform to Atrezzo Next Generation. The Atrezzo Next Generation (ANG) platform is an improved interface with enhanced security features such as Multi-Factor Authentication (MFA). ANG brings the Maine Administrative Services Organization (ASO) an even more flexible, intuitive, and highly automated system that streamlines the utilization review and reporting processes for clients and providers.
Clarification of Biosimilar Ocular Use
MaineCare implemented a Biosimilar Preferred Drug List (PDL) this past May that establishes preferred and non-preferred Physician-Administered Drugs (PADs). Preferred drugs are available without a Prior Authorization (PA), and non-preferred drugs require a PA.
Link to HCBS Compliance Form for Waiver Services Providers, CR 99064
Attention Section 28 Providers: Update on Type 92 Early Childhood Provider Certification Letters, CR 71822
MaineCare now requires accurate certification information for Type 92 providers prior to approval for that provider type. The certification consists of an approval letter from the Maine Department of Education that indicates the approval period.
NF and RCF Letters Are Available
The Department has posted Rate Letters for State Fiscal Year 2023 for Nursing Facilities (NFs) and Residential Care Facilities (RCFs, PNMI Appendix C) to the Health PAS Online Portal, and the rates have been loaded into MIHMS. Details about the timing of these rates were announced in a prior bulletin on August 31, 2022.
Dental Changes Effective September 28, 2022
On September 23, 2022, the Department adopted Section 25, Dental Services and Reimbursement Methodology, which is effective beginning today, September 28, 2022. This rule makes the following changes to covered service limits, prior authorization (PA) requirements, and rate changes that differ from the emergency Section 25 rule that has been in effect since July 1, 2022.
Covered Service Changes
MaineCare Benefits Manual, Chapter II, Section 25, Dental Services (repeal); Chapter III, Section 25, Allowances for Dental Services (repeal); Chapter II, Section 25, Dental Services and Reimbursement Methodology (this rule replaces the two repealed rules
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the propose