Attention Providers of Section 21 Agency Home Support: Information About Staffing Thresholds

This message confirms that as of January 1, 2025, the Department is enforcing the 92.5% minimum staffing threshold for Agency Home Supports under MaineCare Benefits Manual, Section 21. Enforcement of this standard was deferred from July 1, 2024 to December 31, 2024, due to labor market conditions. The Department analyzed Agency Home Support and determined that per person units delivered now surpass pre-pandemic levels, indicating an easing of staffing challenges. Please see the notice from June 28, 2024 for more

Nursing Facilities (NFs) and Residential Care Facilities (RCFs), PNMI, Appendix C Rate Letters

Effective January 1, 2025, you can find NF and RCF rate letters on the secure Health PAS Online Portal. We will implement these new rates by February 1, 2025.

Attention RCFs:

MaineCare updated RCF rates to reflect the removal of the Service Provider Tax (SPT) from the direct care rate and updated the fixed costs based on the most recent audited cost reports.

For questions about the rates, please contact the individual listed on the rate letter.

Revision of Medicare Standardization Rates

Effective January 1, 2025, the Centers for Medicare & Medicaid Services (CMS) revised certain rates. To align with these changes, MaineCare is in the process of revising reimbursement rates for Medicare covered codes and services, in the sections listed below. The new rates will reflect 72.4% of the Medicare rates with a retroactive effective date of January 1, 2025, to align with Medicare. Providers can expect these new rates to be implemented by the end of January 2025.

Final Draft Rates for Certain Medicare Covered Family Planning Services and Long-Acting Reversible Contraception (LARCs): Sections 14, 30, 31, 45, 90 & 103

The final rates and rate methodology are available on the Rate System Reform webpage. The Department anticipates implementation of the methodology and rates by early spring, with a retroactive effective date of July 1, 2024.   

Missing Clients in Sandata

Some providers responsible for Electronic Visit Verification (EVV) may experience issues with missing clients who are approved for services. This may impact the ability to create visit records and submit claims for visits. If you experience this issue, and have not reported it, please contact Provider Services at: 1-866-690-5585.   

We appreciate your patience during this time and understand the impact it may have on your operations. We are working with Sandata to resolve the issue as quickly as possible and will send another notice once it’s resolved. 

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