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The Centers for Medicare & Medicaid Services (CMS) issued updated guidance on the use of 340B modifiers for providers and suppliers participating in the 340B Drug Pricing Program and who bill separately for payable Part B drugs and biologicals.
Effective January 1, 2025, providers must use the TB modifier on all 340B drugs provided to MaineCare members whether billing MaineCare for primary or secondary claims.
Acentra Health will end all Section 28 “School-Related SPT Exempt” authorizations after December 31, 2024.
Effective January 1, 2025, you will no longer be able to use the following procedure codes:
H2021HI School-Related, One-to-One (BHP), and SPT Exempt
H2021HK Specialized School-Related and One-to-One – SPT Exempt
Effective January 1, 2025, Section 103, RHC CY25 rate letters will be accessible on the secure Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: Exchange > Reports > Rate Setting Letters.
If you have questions about accessing the letters, please contact Provider Services at 1-866-690-5585.
The Department is in the process of updating reimbursement rates for Medicare covered codes and services for the sections of policy noted below, with an effective date of January 1, 2025. The new rates will reflect 72.4% of the most recent 2025 Medicare rates.
The Department is proposing to amend 10-144 CMR Chapter 708 concurrently with the rulemaking proposal to amend the related rule Chapter 707 to expand the age eligibility for the Maine Center for Disease Control and Prevention - Breast and Cervical Health Program (MBCHP) to qualifying participants who are 21 to 34 years old. The Department is proposing non-substantive changes to the rule format, including a revised title, and language for conformity with agency standards.
The Department is proposing to amend 10-144 CMR Chapter 707, Rules Relating to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Maine, to expand the age eligibility for the Maine CDC Breast and Cervical Health Program (MBCHP) to also include participants who are 21 to 34 years old. The Department is proposing changes to the order of prioritizing program expenditures that incorporate the additional age group in the event of financial exigency.
SUPPLEMENTAL NUTRITION ASSISTANCE Program (SNAP) RULES
10-144 C.M.R. Ch. 301
Section 777-4
Rule #235A – Procedures for Replacing Benefits Stolen Electronically
SUBJECT: Repeal of 14-197 C.M.R. Chapter 3 Definition of Mental Retardation and Autism; Appeal Procedure and replace with 10-149 C.M.R. Chapter 5 § 2 Developmental Disability Services for Adults with an Intellectual Disability or Autism Spectrum Disorder.
This memo gives notice of proposed rulemaking re: Developmental Disability Services for Adults with an Intellectual Disability or Autism Spectrum Disorder.
The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by CMS to conduct program oversight, administration, and integrity.
Jamie Bourque will lead the office in establishing a State-wide, data driven approach to prevention and response work