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Effective October 1, 2024, in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, the Department retroactively updated the Physician Drug Rates. On November 20, 2024, the new rates were implemented for billing, and we then processed claims submitted on or after November 20, 2024, at the new rates.
Effective August 1, 2024, MaineCare updated the seasonal flu codes and rates for hospitals in alignment with the Centers for Medicaid Services (CMS). The new codes are now available for billing. No provider action is required as we will reprocess claims that denied in error.
See the notice from September 6, 2024, for the seasonal flu codes.
10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules -Section 999-3
Rule #236A – FFY25 Budgeting Figures
10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules - Section 999-2
SNAP Rule #234A – ABAWD Geographic Exemptions
Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment
AGENCY: Department of Health and Human Services, Office of MaineCare Services
NATURE OF PROPOSED CHANGES: The state is requesting a budget neutrality projection adjustment for two components of the current 1115 Waiver Substance Use Disorder (SUD) Care Initiative.
There are currently no proposed rules open for public comment.
MaineCare is extending the deadline for written comments on the CCBHC Medicaid Demonstration draft rate methodology to November 22, 2024, by 11:00 AM. Please see the presented materials notice that followed the public forum, for more information. Comments should be submitted to RateReform.OMS@maine.gov.
Maine CDC is adopting amendments to its Tanning Facilities Rule, that include updating the rule to reflect recent changes to Maine statute (22 MRS § 689-A(2)) which prohibit minors from using a tanning device. These amendments protect individuals from the harmful effects of exposure to UV radiation from indoor tanning by prohibiting minors from using indoor ultraviolet tanning facilities.
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 45, Hospital Services
NATURE OF PROPOSED CHANGES: Effective November 2024 the Department plans to amend existing hospital supplemental pool payment amounts to the following:
On September 16, 2024, MaineCare sent a message advising pharmacies that copays for pharmacy services would resume effective October 1, 2024, in conjunction with the end of the American Rescue Plan Act (ARPA).