• Read more about Attention Providers of Section 67 Nursing Facilities (NF): Optional State Assessment (OSA) and Federal Minimum Data Set (MDS) Assessments Required

Effective October 1, 2023, Federal MDS assessments no longer support Resource Utilization Group (RUG) III/IV grouper calculations. MaineCare reimburses NFs using a modified RUG III grouper calculation. NFs perform MDS assessments on NF residents which determines both resident level of care and NF reimbursement. This federal change will impact how NFs submit information to the Centers for Medicare & Medicaid Services (CMS) and MaineCare.   

Oct 10, 2023

Today, the Maine Department of Health and Human Services (DHHS) released updated data on the resumption of MaineCare eligibility reviews after the COVID-19 Public Health Emergency, known as “unwinding.”  “MaineCare” is the name of the state’s Medicaid program. This update with August 2023 data is available on the MaineCare Renewals Data Dashboard.

• Read more about Maine DHHS releases updated data on MaineCare eligibility reviews

• Read more about 10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules; Section 999-3; SNAP Rule 231P - FFY24 Budgeting Changes

Maine exercises an option for Broad Based Categorical Eligibility under 7 C.F.R.

• Read more about 10-144 C.M.R. Chapter 301; Supplemental Nutrition Assistance Program (SNAP) Rules; Section 999-3; Emergency Rule 231 - FFY24 Budgeting Changes

Federal rule 7 C.F.R. § 273.9 (d)(6)(iii)(B) requires that standard utility allowances are updated each year, effective October 1. USDA Food and Nutrition Services (FNS) annually approves utility allowances calculated by states. The calculations are based on the change in the Consumer Price Index for fuel and utilities, between June 2022 and June 2023.

• Read more about Maine CDC Announces Possible Hepatitis A Exposure at Lewiston Restaurant

Potentially exposed patrons encouraged to contact a health care provider

AUGUSTA — The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of hepatitis A in a Lewiston food service worker. Hepatitis A is a contagious liver disease caused by the hepatitis A virus. It can spread through person-to-person contact or by consuming contaminated food or water.

• Read more about Pilot Program for Transitional Services

This rule change is proposed to repeal a pilot program that was established in 1988 to provide transitional services for adults aged 20-26 that were clients of the Office of Aging and Disability Services, formerly the Office of Adults with Cognitive and Physical Disabilities. The program offered a method of funding that was otherwise unavailable or not reimbursable under existing funding systems and has not been operational for several years as redundant and similar services have since been adopted and implemented federally and statewide to support the target population.

• Read more about Electronic Visit Verification (EVV) Phase 2 Trainings

The EVV requirements for Home Health providers delivering services under Section 40 were implemented on January 1, 2023.

We continue to offer weekly provider and aggregator trainings. All trainings are online via Microsoft Teams.

NOTE:  The Absorb training system has been updated to allow providers to register for trainings more than once.

EVV Training Schedule

• Read more about Revalidate with MaineCare to Avoid Claim Denials

The Affordable Care Act (ACA), Section 6401, states that almost all provider types must revalidate their information with MaineCare every five years. Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidations began in January 2022.  

• Read more about ​​COVID-19 Vaccine Updates for Fall 2023​

MaineCare will continue to provide full coverage, without cost sharing through September 30, 2024, for the COVID-19 vaccine and its administration as required by the American Rescue Plan Act (ARPA) of 2021. The ARPA requirement applies only to those persons with current MaineCare coverage.

• Read more about ​Non-Emergent, Emergency Department (ED) Pricing Failure, TR 113880

MaineCare identified an overpayment of some emergency room hospital claims. These claims received the Ambulatory Payment Classifications (APC) rate vs. the non-emergent rate. The affected date range is July 01, 2021, through March 31, 2023. MaineCare will reprocess all affected claims and no provider action is needed.