• Read more about Rules Relating to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Maine; 10-144 CMR Ch. 707

The Department adopted amendments to 10-144 CMR Ch. 707, Rules Relating to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Maine to expand coverage and eligibility for the Maine CDC Breast and Cervical Health Program (MBCHP) to include qualifying participants who are 21 to 34 years old and the addition of human papillomavirus (HPV) testing as another service in rule that MBCHP will cover when determined medically necessary and provided by a participating MBCHP Provider.

• Read more about Section 55, Laboratory Services: January 1, 2025, Rate Update, CR 129908

Effective January 1, 2025, MaineCare updated the rates for Section 55, Laboratory Services. The new rates were implemented for billing on February 26, 2025. You may view the updated fee schedule on the Rate Setting page of the Health PAS Online Portal.

• Read more about Nursing Facility (NF) Bariatric Care Document Available

The new criteria sheet NFs Bariatric Care is available by logging into your Trading Partner Account in the secure section of the Health PAS Online Portal. Once logged in, please follow this pathway: MaineCare Information > Prior Authorizations > Manual, Forms, and Criteria Sheets > Policy Section 67, NF Services. 

If you have questions, please email Provider Services or call 1-866-690-5585. TTY users dial 711.

• Read more about Attention Providers: Important Update to Preferred Diabetic Supply List (PDSL)

Effective May 1, 2025, Lifescan products, including One Touch test strips and meters, will no longer be included on the PDSL.

To ensure a smooth transition, we recommend providers begin changing to a preferred blood glucose meter and test strip combination ahead of this date.

• Read more about Attention Providers: Transforming Maternal Health (TMaH) Model & Maternal Health Rural Regional Planning Webinar

The Transforming Maternal Health (TMaH) model is a grant-funded initiative through the Centers for Medicare and Medicaid Services aimed at improving maternal and perinatal health outcomes. Maine was selected for participation in December 2024, and the state’s TMaH initiative officially launched in January 2025.

• Read more about Sections 18 and 20, Home and Community Based Services for Adults with Brain Injury or other Related Conditions: Rate Correction - CR 130249

As previously announced in September of 2024, MaineCare removed all documented add-on amounts associated with the service provider tax for MaineCare reimbursements, effective January 1, 2025.

The codes and modifiers listed in the table below for sections 18 and 20 are now updated to reflect this rate change and no provider action is needed.

• Read more about Section 45, Hospitals & Section 90, Physicians: 2024 & 2025 Drug Rate Updates

MaineCare updated multiple codes and rates retroactively due to a rate update from the Centers for Medicare & Medicaid Services (CMS). The new rates are effective April 1, 2024, through March 31, 2025.  

See the table of affected codes below for the effective dates and new rates.  

• Read more about MaineCare Notice of Agency Rulemaking Adoption, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities

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.

Apr 4, 2025

Quality, Excellence, Staffing, and Teamwork (QuEST) are key to improving value for Maine’s nursing home residents.

• Read more about DHHS Partners with Maine Health Care Association and Long-Term Care Ombudsman Program on a QuEST for Nursing Home Quality

• Read more about CORRECTION: Home and Community Based Supports (HCBS) Sections 18, 20, 21, 29, and New Lifespan Waiver: Presented Materials and Comment Deadline

Our earlier notice incorrectly listed Section 19, as included in the bulleted materials. Please see the corrected information below. 

On April 14, 2025, the Department with its vendor, Burns and Associates, which is a division of Health Management Associates (HMA-Burns), held an online public meeting to present the recommended draft rates and rate models in addition to rationale for Sections 18, 20, 21, 29, and the new Lifespan waiver.