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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 25, Dental Services and Reimbursement
AUGUSTA– The Maine Department of Health and Human Services (DHHS) announced today that it received $1.7 million in federal grants to foster resiliency for individuals impacted by severe weather this past winter.
MaineCare discovered that some hospital non-emergency claims failed to price correctly and were overpaid. This occurred when there was more than one emergency room service on the claim, for claims submitted for Dates of Service from January 1, 2022, and March 31, 2024. MaineCare reimburses differently in cases where non emergent use of the emergency room is determined.
No provider action is required as MaineCare will re-process these claims.
The proposed rule change would update the Public Assistance Manual Temporary Assistance for Needy Families (TANF) consistent with legislative changes made to 22 M.R.S. § 3769-C made by P.L. 2024, Ch. 622, An Act to Reduce the Number of Children Living in Deep Poverty by Adjusting Assistance for Low-income Families.
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.
The Department is proposing this routine technical rulemaking following the adoption of amendments by emergency rulemaking effective May 28, 2024, that qualified the use of a dry gas standard under 10-144 CMR chapter 269 - Rules Governing Self-Contained Breath Alcohol Testing Equipment. The Department is ensuring that the dry gas standard provisions added for calibrating units in the emergency rule do not expire on August 26, 2024, with the emergency rule (5 MRS 8054(3)).
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The mission of the Maine Department of Health and Human Services (DHHS) is to provide health and human services to the people of Maine so that all persons may achieve and maintain their optimal level of health and their full potential for economic independence and personal development.
The Office of Maine Care has taken broad steps to fulfill DHHS’s mission through new Justice Initiatives, which is comprised of 3 Parts.
MaineCare will increase reimbursement rates for certain services under Sections 67 NFs and 97, Appendix C, RCFs effective July 1, 2024, through a Cost-of-Living Adjustment (COLA), in alignment with MRS Title 22, 3173-J (referred to as ‘Rate Reform Statute’). The COLA is equal to an increase of 4.91% above the currently established rate(s), which is based on the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index for nursing homes and adult day care services as required under Maine P.L. 2017, ch. 460 (see 22 MRSA §1708, sub-§3, ¶F for NFs).
The Section 97, Appendix F, FY 2025 rate letters will be accessible on the secure Health PAS Online Portal by July 1, 2024. To view them, log into your Trading Partner Account and follow this pathway: File Exchange > Reports > Rate Setting Letters.
If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585.
For questions about the content of these letters, please contact Rate Setting directly by using the contact listed on each letter.