• Read more about Guidance for Psychiatric Hospitals Seeking Prior Authorization (PA) for Mental Health Intensive Outpatient Services​

Psychiatric Hospital providers seeking to bill for Mental Health Intensive Outpatient (MH-IOP) Services under MaineCare Benefits Manual (MBM) Ch. II, Section 46.05-3 will be asked to submit PA requests through Atrezzo. Acentra Health (formerly Kepro) will review these requests in accordance with the substantive standards for MH-IOP services adopted in the November 9, 2022, revision of MBM Ch. II, Section 65 (Behavioral Health Services).

• Read more about MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter I, Section 4, Telehealth Services

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes.  The MaineCare Benefits Manual is available on-line at the

• Read more about MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual Chapter I, Section 4, Telehealth Services

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This

• Read more about Electronic Visit Verification (EVV) Trainings and Forums

The federal deadline to implement the EVV requirements for Home Health providers delivering services under Section 40 and Hospice providers delivering services under Section 43 happened January 1, 2023.

We continue to offer weekly provider and aggregator trainings and forums. All trainings and forums are online via Microsoft Teams.

NOTE:  The Absorb training system has been updated to allow providers to register for trainings and/or forums more than once.

• Read more about Community Partnerships and Financing Strategies to Address Health-Related Social Needs

HRSN Webinar Series

NEW ENGLAND RURAL HEALTH ASSOCIATION

WEBINAR SERIES

Thank you to the Maine Health Access Foundation for their support on this webinar series!

• Read more about Microdyn Update for Ambulatory Payment Classifications (APCs), and Diagnostic Related Groups (DRGs), CRs 116565, 117447, & 117448

Effective June 3, 2023, the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates in MIHMS were completed.        

The following CMS documents provides the details of the APC updates:    
   

April 2023 Integrated Outpatient Code Editor Specs:     

• Read more about Announcing Acentra Health: A New Era for Client Network Services, Inc (CNSI) and Kepro

CNSI and Kepro are now Acentra Health.  

Acentra Health is focusing on expanding access to care, improving outcomes, enhancing quality, and lowering costs for the populations we serve.  

• Read more about Attention Section 97, Appendix D, Private Non-Medical Institutions (PNMI): Rate Determination Initiation Notice for Therapeutic Foster Care Services

This bulletin provides notice that the Department has initiated a Rate Determination Process* for Therapeutic Foster Care services under Section 97, Appendix D, PNMI of the MaineCare Benefits Manual. MaineCare’s Rate Reform Unit will conduct this rate determination.

• Read more about Johnson & Johnson/Janssen COVID-19 Vaccine No Longer Authorized for Use, CR 118354

On June 1, 2023, the Food and Drug Administration (FDA) revoked the Emergency Use Authorization (EUA) for Johnson & Johnson/Janssen COVID-19 vaccine. As a result, the following codes are no longer authorized for use:  

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

As previously noticed, MaineCare and its vendor are hosting several work groups with interested stakeholders to obtain important feedback as part of the rate determination process.