DHHS → node
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services (DHHS), MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE:
10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
PROPOSED RULE NUMBER:
CONCISE SUMMARY:
The proposed rule change would update Section 2, APPLICATION PROCESS, consistent with a legislative change to 22 M.R.S. § 3174-LLL made by P.L. 2023, ch. 412. Effective retroactive to July 1, 2024, individuals who are enrolled in Medicaid and/or Medicare Buy-In (MSP), who are eligible for Medicare Part D, and meet the income criteria in Section 2.2, are deemed to be eligible for and enrolled in DEL. These individuals do not need to file a separate application.
In addition, the proposed rule would make the following changes:
MaineCare’s EPSDT program allows MaineCare members under the age of 21 to receive medically necessary services that are not typically covered due to limits on the type, frequency, or duration of the service. These services can include preventive, dental, developmental, behavioral health, and specialty services.
Comprehensive EPSDT program resources are now available for providers:
MaineCare is hosting a second dental forum on August 28, 2024, from 12:00 PM – 1:00 PM where we will share information and look forward to your feedback, ideas, and questions about MaineCare dental services.
The beginning of the forum will include a presentation from MaineCare about specific topics. After the presentation, we will open the forum for questions and discussion.
All MaineCare Providers are required to update any change in their enrollment within 10 days of the change per Chapter I, Section 1.03-1(B) of the MaineCare Benefits Manual (MBM). These updates can be but are not limited to:
Effective July 1, 2024, the Critical Access Hospital (CAH) swing bed rate and Nursing Facility (NF) days awaiting placement (DAP) rates have been recalculated for State Fiscal Year 2025. You can view both related memos on the rate setting page of the Health PAS online portal.
Notice of Agency Emergency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE:
10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
EMERGENCY RULE
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE:
10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
EMERGENCY RULE
This message is an update to a previous communication regarding the implementation of Section 17 COLA rates effective January 1, 2024. Implementation of these rates is delayed until August 14, 2024. We apologize for any inconvenience.
In June of 2023, the Office of MaineCare Services initiated a rate determination for Section 45, Hospital Services with the goal of incentivizing quality care and cost effectiveness and updating an outdated reimbursement methodology.