Attention Providers of Section 17 and Section 92 Services

Acentra Health and the Office of Behavioral Health previously sent an announcement on May 29, 2024, regarding the ability for providers to run their agency’s hold for service reports from the Atrezzo portal. We would like to clarify the process of how a member is removed from the agency’s hold for service report. 

A member will only be removed from the waitlist under the following scenarios:  

  • The member is receiving the referral service from the referring provider  

  • There has been an approved Referral Refusal for the referring provider  

​MaineCare Residential Substance Use Disorder (SUD) Treatment Providers – Utilization Management (UM) Process Update

One of the tasks associated with MaineCare’s 1115 SUD waiver is the “establishment of a Utilization Management (UM) approach for appropriate access and level of care for SUD services, including an independent process for reviewing placement in SUD residential treatment”. This UM is a component of Maine’s Implementation Plan and Special Terms & Conditions approved by the Centers for Medicare & Medicaid Services (CMS) for this waiver and was implemented in July 2023. 

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 45, Hospital Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 45, Hospital Services

NATURE OF PROPOSED CHANGES: The Department plans to address the following changes in hospital reimbursement:

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 13, Targeted Case Management Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 13, Targeted Case Management Services

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Family Planning Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Family Planning Services

NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement of certain family planning services, effective July 1, 2024. These changes are as follows:

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