MaineCare Benefits Manual, Section 90, Physicians Services
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 90, Physicians Services
MaineCare Benefits Manual, Section 65, Behavioral Health Services
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Behavioral Health Services
NATURE OF PROPOSED CHANGES: The Department plans to update reimbursement for Healthcare Common Procedure Coding System (HCPCS) code H2030 (clubhouse services) from $7.31 to $8.67 effective May 1, 2023.
National Diabetes Prevention Program (NDPP): Rate Determination Comment & Response Summary
On December 16, 2022, the Office of MaineCare Services initiated a rate determination for the NDPP, a new service that will be the Proposed MaineCare Benefits Manual (MBM), Chapter II, Section 71. MaineCare held a public forum on February 6, 2023, to present the draft service, rates, and methodologies to interested stakeholders and accept public comment.
Attention Section 65, Behavioral Health Providers: Clubhouse Services Revised Rate, CR 117161
As a result of the Department’s recent Behavioral Health Services rate study, we increased the rate for Clubhouse Services by 15% and implemented that change with an effective date of January 1, 2023. The Department is now revising the rate to account for transportation costs with an effective date of May 1, 2023.
The new rate is $8.67 per 15-minute unit and is now available for billing in MIHMS for dates of service on or after May 1, 2023.
MaineCare Updates: Preparing for the End of the Public Health Emergency (PHE)
At the beginning of the COVID-19 pandemic, the federal government declared a PHE and relaxed certain requirements to ensure Medicaid members could continue to access healthcare services. The federal government has declared that the PHE will end on May 11, 2023.
Starting May 12, 2023, some billing flexibilities and how MaineCare members access health care services will revert to how they were administered prior to the declaration of the PHE.
Update to the Rounding Rule Enforcement Date
This notice is an update to the e-message sent on January 20, 2023. MaineCare is extending its delay of the enforcement of the rounding rule by one month, from May 1, 2023, to June 1, 2023, to allow further time for necessary system changes.
Maine CDC Issues Additional Advisories on Eating Freshwater Fish Due to PFAS Contamination
AUGUSTA - The Maine Center for Disease Control and Prevention (Maine CDC) today issued updated and additional freshwater fish consumption advisories, recommending limiting consumption of all fish or certain fish from six waterbodies in Maine. Two of the advisories are expansions of those issued last year for seven waterbodies, while four bodies of water are new additions to the list, which now totals 11.
Update to Prior Authorizations (PA) for Gender Affirming Medical and Surgical Treatment
On September 15, 2022, the World Professional Association for Transgender Health (WPATH), updated the Standards of Care for the Health of Transsexual, Transgender, and Gender Diverse People to Version 8.
Information for Providers Regarding the End of the Public Health Emergency (PHE)
At the beginning of the COVID-19 pandemic, the federal government declared a PHE and relaxed certain requirements to ensure Medicaid members could continue to access healthcare services. The federal government has declared that the PHE will end on May 11, 2023.