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We implemented a system update that changed the Diagnostic Related Groups (DRG) hospital outlier methodology in error. This affected claims with dates of service from July 1, 2024, through December 31, 2024. We will adjust affected claims, and no provider action is needed.
Effective January 1, 2025, you can find NF and RCF rate letters on the secure Health PAS Online Portal. We will implement these new rates by February 1, 2025.
Attention RCFs:
MaineCare updated RCF rates to reflect the removal of the Service Provider Tax (SPT) from the direct care rate and updated the fixed costs based on the most recent audited cost reports.
For questions about the rates, please contact the individual listed on the rate letter.
Effective January 1, 2025, the Centers for Medicare & Medicaid Services (CMS) revised certain rates. To align with these changes, MaineCare is in the process of revising reimbursement rates for Medicare covered codes and services, in the sections listed below. The new rates will reflect 72.4% of the Medicare rates with a retroactive effective date of January 1, 2025, to align with Medicare. Providers can expect these new rates to be implemented by the end of January 2025.
The final rates and rate methodology are available on the Rate System Reform webpage. The Department anticipates implementation of the methodology and rates by early spring, with a retroactive effective date of July 1, 2024.
Sandata resolved the missing client error for EVV.
If you encounter challenges or have questions about EVV, please email Gainwell Provider Services.
Some providers responsible for Electronic Visit Verification (EVV) may experience issues with missing clients who are approved for services. This may impact the ability to create visit records and submit claims for visits. If you experience this issue, and have not reported it, please contact Provider Services at: 1-866-690-5585.
We appreciate your patience during this time and understand the impact it may have on your operations. We are working with Sandata to resolve the issue as quickly as possible and will send another notice once it’s resolved.
10-144 C.M.R. Ch. 331; Public Assistance Manual
Temporary Assistance for Needy Families
(TANF) Manual
Chapter V
TANF Rule #122A – Mileage Reimbursement Update
Rate Letters
The CY 2025, ICF-IID rate letters are now available on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following 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 the letters, please contact Rate Setting directly by using the contact listed on the letters.
All MaineCare enrolled providers are requirement to provide at least a 30-day notice to the Office of MaineCare Services (OMS) if they are closing one of their programs or their agency. This requirement is listed in the MaineCare Benefits Manual (MBM) Chapter I Section 1.03-6.
The Office of MaineCare Services (OMS) provides the following guidance to service providers and interested parties in accordance with LD 346, which requires OMS to reimburse parents providing Home Health Aide (HHA) services to eligible minor children under MaineCare Benefits Manual (MBM), Section 40, Home Health Services.