Jun 6, 2023

While the Legislature considers budget proposals for future MaineCare reforms, the Department of Health and Human Services (DHHS) Office of MaineCare Services continues its implementation of payment rates already developed under the landmark law (P.L. 2022, Ch. 639 (PDF)). Specifically, the Office of MaineCare Services implemented reformed payment for Federally Qualified Health Centers effective March 1 and will implement an array of cost-of-living adjustments effective July 1.

• Read more about MaineCare implements new rate reforms supported by current services budget

• Read more about Attention Behavioral Health and Targeted Case Management Providers - Behavioral Health and Targeted Case Management Supplemental Payment Reporting

As a follow-up to our June 21, 2022, e-message regarding Behavioral Health and Targeted Case Management supplemental payments for providers of:

• Read more about Attention Section 45, Hospital Services: Rate Determination Initiation Notice 

This bulletin provides notice that the Department has initiated a Rate Determination Process* for Hospital Services, with the exception of Distinct Psychiatric and Substance Use Disorder Unit services for which the Department recently completed a rate determination, under Section 45 of the MaineCare Benefits Manual.

• Read more about CORRECTION: Attention Providers of Section 67 Nursing Facilities (NF) and Section 97, Residential Care Facilities (RCFs, PNMI Appendix C): Provider Rate Methodology Workgroup Presented Materials 

MaineCare, and its vendor will host the 5th Rate Workgroups meeting on June 26, 2023. Presented materials will then be posted to the Rate System Reform webpage shortly after. Please watch for future notices. 

• Read more about Section 50, Intensive Care Facilities (ICF) Rate Letters for Fiscal Year (FY) 2024 Now Available

The FY 2024 Section 50 ICF rate letters are now available on the secure Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: Exchange > Reports > Rate Setting Letters.    

• Read more about Extended-Release Buprenorphine Clinical Use Criteria

In order to promote access to Sublocade, Extended Release Buprenorphine (XRB), MaineCare may engage in rulemaking. In the meantime, providers may bill the medical benefit for XRB without Prior Authorization (PA) if their documentation meets the criteria outlined below. The criteria will be available on the Preferred Drug List after the July 2023 update. Failure to meet these criteria could result in sanctions.    

• Read more about Roster Billing Hepatitis A Vaccination Codes – CR 116982

MaineCare added Hepatitis A vaccination codes to the Roster Billing code list.  Roster Billing Specifications can be found here.    

• Read more about Maine Point of Purchase System (MEPOPS) Blackout Period 

On June 28, 2023, at 8:00PM, MEPOPS will be unavailable for eight (8) hours, due to system maintenance. Pharmacy claims will not be adjudicated during this time. We apologize for any inconvenience this may cause.    

If you have any questions regarding this blackout period, please call the Change Healthcare Provider Help Desk at 1-888-420-9711.  

• Read more about Coverage of Medications for Treatment of Opioid Use Disorder in Pregnancy

MaineCare covers brand name Suboxone film and generic buprenorphine/naloxone tablets as “Preferred” covered products for treatment of opioid use disorder (OUD) as they are the most cost-effective forms of treatment on the MaineCare Preferred Drug List (PDL). Providers may choose to prescribe buprenorphine/naloxone combination product or buprenorphine monotherapy for patients who are pregnant.      

• Read more about Annual 1115 Substance Use Disorder (SUD) Waiver Post Award Forum

In July 2022, the Office of MaineCare Services received federal approval to expand services for MaineCare-enrolled parents with SUD, who are involved with Child Protective Services (CPS), or at risk of being involved with CPS. The expanded services are available through three pilot programs under a Medicaid SUD 1115 Waiver first approved by CMS on December 22, 2020, which allows federal Medicaid reimbursement for SUD treatment in facilities with more than 16 beds.