• Read more about MaineCare Benefits Manual (MBM), Chapter VI, Section 3, Primary Care Plus (PCPlus) – Rate Determination Kickoff Meeting & Primary Care Utilization Review Meeting

On August 4, 2025, the Department will host a kick-off meeting to introduce the next phase of MaineCare’s PCPlus reform work, and to receive feedback on your experiences and insights from participating in the PCPlus model. This is an important step to shape the next phase of the PCPlus Alternative Payment Model (APM). This meeting was originally scheduled for July 16, 2025, but we  postponed it due to technical difficulties.

• Read more about RESCHEDULED: Primary Care Plus (PCPlus) Model Advancement Kickoff Meeting and PCPlus Phase II Alternative Payment Model (APM) Design Kick-off Meeting

Please join us on Monday, August 4, 2025, to learn about the next phase of MaineCare’s PCPlus reform work. This session will be an opportunity for practices to provide feedback on your experiences and insights as you participate in the PCPlus model. Your input will help shape the next phase of the PCPlus APM. 

PCPlus Model Advancement Kick-off Meeting:

Discussion Topics:

• Read more about MaineCare Notice of Agency Waiver Renewal

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the 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 Secretary of State’s website.

• Read more about MaineCare Notice of Agency Waiver Renewal

Notice of Agency Waiver Renewal

AGENCY:  Department of Health and Human Services, MaineCare Services

RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder

WAIVER: ME.0467, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Waiver

• Read more about Tips and Tricks for Password and Username Resets on the Health PAS Online Portal, CR 131667

A new document called ‘Tips and Tricks for Password and Username Resets’ has been added to the Health PAS Online Portal. The document will instruct you how to reset your password and retrieve your username. If you have questions, please contact Provider Services by email or call 1-866-690-5585, Option 3. TTY users dial 711.  

• Read more about Guidance for Section 65 Medication Management Code Changes and Duplication with Intensive Outpatient Programs (IOP)

MaineCare is not removing H2010 HF

MaineCare previously sent a notice saying we will remove H2010 HF from Atrezzo, but we decided not to go forward with this change. This means medication management providers do not need to discharge members from authorizations for H2010 HF in Atrezzo by November 12, 2025. You may continue to use this code and modifier for medications for opioid use disorder (MOUD) medication management.

Reasons for Not Removing the Code and Modifier

• Read more about New Health PAS Online Portal Downtimes

The State of Maine has identified a technical issue within the Health PAS Online Portal. Gainwell will need to shut down the system for maintenance for periods of time. In an effort to minimize provider impact, Gainwell will shut down the portal for the following periods of time when data shows the lowest user activity:

• Read more about Section 65, Mobile Crisis Intervention Response Services – Final Draft Rate Model Presented Materials, Comment Summary with Department Response, and Final Draft Rates

On July 15, 2025, the Office of MaineCare Services (OMS) with our vendor presented revisions to the previously proposed community-based Mobile Crisis Intervention Response service rates and model.

• Read more about Billing Requirement for the Emergency Services Limited Benefit Package

Emergency Services, also known as Emergency MaineCare, is a limited benefit that covers emergency medical services to stabilize the emergency condition only. For proper reimbursement, providers must use Admission Type “1” on the UB04 claim form or the Emergency Indicator “Y” on the CMS 1500 claim form.

• Read more about Prescribing Providers Must Enroll in MaineCare