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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.
The public forum to present revisions to the previously proposed draft rates and model for PRTF services that was scheduled for November 6, 2024, has been postponed. The Department will reschedule this forum and send notice of the new date and time. Please watch for a future notice. We appreciate your ongoing patience and apologize for any inconvenience.
For questions, please contact Dwayne Parsons, MaineCare’s Manager of Rate Setting and Reform.
All vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered by MaineCare pharmacy benefit without a member copayment, this includes influenza vaccines.
In preparation for the 2024-2025 Influenza (Flu) season, please review the MaineCare preferred vaccines listed below. These vaccines do not require Prior Authorization (PA).
Influenza vaccines:
Effective November 1, 2024, MaineCare will only accept Health Resources and Services Administration (HRSA) Notice of Award (NOA) to update the license term date.
FQHC providers are required to update their license term date annually and provide their latest NOA. Previously, MaineCare also allowed the Federal Tort Claims Act (FTCA) document to count as the NOA but we will no longer accept them to update the license term date. Providers must update the license term date with the end date listed on the Budget Period within the NOA to avoid delays.
If you see a member has SPLB MaineCare coverage when verifying eligibility on the Health PAS Online Portal, do not assume the coverage is hospital inpatient services only. There are several different SPLB coverage types and the services MaineCare reimburses for depends on which limited benefit coverage the member receives.
Contact Gainwell Provider Services at 1-866-690-5585 to verify if the procedure code you intend to bill is covered.
The Office of Aging and Disability Services (OADS), in collaboration with the National Alliance on Mental Illness (NAMI) Maine, is excited to announce a virtual De-Escalation training opportunity scheduled for Tuesday, December 10, 2024, from 3:00 PM – 5:00 PM.
This training is available for caregivers providing care to Section 12, 19, and 96 members and the cost is free! Caregivers can include personal support staff, attendants, home health aides, nurses, or other natural and family supports.
Effective October 1, 2024, MaineCare has updated the Hospice rates. New rates were implemented for billing on October 23, 2024. You may view the fee schedule on the Health PAS Online Portal.
Adjustments for affected claims with dates of service October 1, 2024 – October 23, 2024:
We are rescheduling the Provider Dental Services Forum to January 22, 2025, 12:00 – 1:00 PM.
MaineCare staff are actively coordinating with Gainwell and Optum/Change Healthcare to better understand providers’ issues with dental billing clearinghouses, to understand who has responsibility for resolving these issues, to push for resolution where possible, and to understand alternatives for providers. Please know that not all issues are within our or Gainwell’s control.
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
In March of 2024, the Department with its vendor Guidehouse Inc., hosted two public forums to present the recommended draft rate methodology and rationale resulting from the rate determination process* that was initiated in 2023. Revisions were then made based on public and written comments received.