DHHS → node
Effective February 15, 2025, the Center for Medicare and Medicaid Services’ (CMS) quarterly updates are complete in MIHMS.
The following CMS documents provide the details of the APC (CRs 129832 & 129843) updates:
When submitting a PA request to exceed quantity limits for services that do not require a PA, please remember to indicate that the request is being made to exceed limits dictated in policy on the PA form. PA requests that do not include this information may be denied for No PA Necessary (NPN) and then you must resubmit the request.
For questions regarding PAs for any dental services, please contact, Shannon Beggs, Provider Relations Specialist.
The contract with Sivantose, Inc – NJ Signa contained an error in the Hearing Aid Procurement contract. The Contract Pricing Link (PDF) document contains several instances of the Healthcare Common Procedure Coding System (HCPCS) code V5180, which was discontinued.
PCPlus providers are invited to a quality webinar series about best practices regarding quality measures in the PCPlus program. This series is intended to educate practices on how to optimize their performance, and payment, while aligning with industry best practices for population and patient health. We will host approximately one webinar a month during 2025.
The Maine CDC Health Inspection Program is proposing to update and clarify safety and wellness standards for its Rules Relating to Boys, Girls, Boys and Girls, Day Camps and Primitive and Trip Camping (10-144 CMR Ch. 208), which was last updated in 2007. The Department is proposing to change the rule title, add and clarify definitions, incorporate application, licensing and enforcement provisions and requirements from its Administration and Enforcement of Establishments Regulated by the Health Inspection Program Rule (Ch.
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.
MaineCare made updates to Section 15, 75, and 95, Medicare covered codes and rates to align with recent revisions made by the Centers for Medicare and Medicaid Services (CMS). These new rates now reflect 72.4% of the most recent 2025 Medicare rates.
Rates were implemented on the dates listed in the table below, for the following sections:
|
Section 15 |
Chiropractic Services |
2/5/2025 |
|
Section 75 |
Vision Services |
On February 14, 2025, MaineCare held an online public meeting to present draft rates and models along with the rationale for PNMI, Appendix D, Temporary High Intensity Services. Interested parties had the opportunity to provide public comments.
MaineCare identified and corrected an error in the MaineCare Dental Metrics reporting.
Due to a data filtering error, previous publications of the MaineCare Dental Metrics Report excluded rendering providers in instances where the billing provider is also the rendering provider on the claim, resulting in understated counts of dental rendering providers.
Pursuant to Rate Reform law (MRS Title 22, 3173-J), MaineCare will host our Annual Draft Rate Determination Schedule Consultation with the TAP on March 14, 2025, from 1:00 PM to 2:30 PM via Zoom. This meeting is open to the public. There will be a limited period of time at the end of the meeting for public comment.
Zoom Meeting