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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.
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.
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.
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.
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.
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.
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Procedure Code |
Start Date |
End Date |
Previous Rate |
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.
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.
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities
ADOPTED RULE NUMBER:
CONCISE SUMMARY: