Attention Providers: Potential Capping of MaineCare Payment Cycles

In January, Governor Mills submitted to the Legislature a Fiscal Year 2025 supplemental budget request for $118 million in General Funds to align projected expenditures with available funding in the MaineCare program. The funding is available through new revenues recently recognized by the State of Maine’s nonpartisan Revenue Forecasting Committee. The Governor’s request must simply be approved by the Legislature in order for the funding to be appropriated to MaineCare.

Residential Private Non-Medical Institution (PNMI) Appendix C Updated Rates for 2025

Some of the 2025 rates for residential care facilities, PNMI Appendix C, were not updated. This caused claims to pay at the 2024 rates. We will update the rates in MIHMS and reprocess claims billed at the 2025 rates. No provider action is needed.

For questions, please contact Bruce Cosgrove, Provider Relations Specialist.

340B Modifier Billing Reminder Extension – CR 129740

Effective January 1, 2025, the modifier JG is no longer valid for 340B claims. We are extending the date to March 1, 2025, to allow providers additional time to update their systems. Please see our previous message for more information.

The Office of MaineCare Services will adjust denied claims between January 1, 2025, and February 28, 2025, and no provider action is required.

Contact Shannon Beggs, Provider Relations Specialist, with questions. 

10-144 CMR Ch. 258; Control of Notifiable Diseases and Conditions Rule-Proposed

Survey for Providers of Personal Care and Home Health Services: Home and Community Based Services (HCBS) & Access Rule

As part of the Maine Department of Health and Human Services’ (DHHS) preparations for the Access Rule’s HCBS requirements, please complete this survey by February 14, 2025.

Please see the Office of Aging and Disability Services (OADS) webpage for more information about Access Rule and HCBS information.

MaineCare Notice of Agency Waiver Renewal, MaineCare Benefits Manual, Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed 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. 

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