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The Office of MaineCare Services is continuing a phased recovery following the service outage that occurred from February 21, 2024, through March 26, 2024, due to the national cyber security issue affecting Change Healthcare. The services below are now restored in MEPOPS:
The Department’s Rate Reform initiative, which was codified into law in August of 2022, with the adoption of P.L. 2021, Ch. 639 (now MRS Title 22, 3173-J), is well under way. Consistent with the Department’s goal of providing a transparent process for rate determinations with opportunities for robust participation from interested parties, the Department is sharing the following resources.
MaineCare Rate System Reform Webpage
The Office of Aging and Disability Services is excited to announce a virtual Mental Health training series opportunity scheduled for Monday, July 8, 2024, Thursday, July 11, 2024, and Monday, July 15, 2024. This training is being provided under collaboration with the National Alliance on Mental Illness (NAMI) Maine and is available for caregivers providing care to Section 12, 19, and 96 members. Caregivers can include personal support staff, attendants, home health aides, nurses or other natural and family supports.
MaineCare’s Delivery System Reform (DSR) Annual Forums will be held on:
This year, MaineCare is turning the tables and wants to hear from YOU! Consider applying to be a presenter.
This is a reminder that the attending provider is required on all UB-04 and 837I claims. MaineCare denies UB-04 and 837I claims submitted without an enrolled attending provider.
The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).
The adopted rule clarifies program requirements in Chapters I, II, IV and V for applicants and the Department as they relate to non-citizen eligibility. These requirements are consistent with 42 U.S.C. § 602 and 45 C.F.R. § 260. Asset limit changes in Chapter III are consistent with P.L. 2023 Ch. 366, An Act to Allow Maine Families to Increase Their Savings by Changing the Asset Limits for Eligibility for the Temporary Assistance for Needy Families Program.
Medicare has updated the documentation guidelines on PMDs, which include Power Operated Vehicles (POV) and Power Operated Wheelchairs (POW). Until such a time as the MaineCare Benefits Manual (MBM), Section 60.08-8(C) is updated, the Prior Authorization (PA) department will review PA requests consistent with the updated requirements that will also be included in the PA criteria sheet located on the Health PAS online portal. Updated PA criteria includes:
This bulletin provides notice that the Department has initiated a Rate Determination Process* for certain HCBS services found in MaineCare Benefits Manual (MBM) Sections 12, 18, 19, 20, 21, 29, 40, 96, and 102 and is now conducting a rate study. Public Consulting Group will be conducting this rate study. MaineCare will provide a list of service categories to be reviewed once the Department's contracted vendor performs a code analysis of the sections.
EVV Providers who are currently using the SMC app through their phone, tablet, or other mobile device should update to the latest version of the app using the Apple Store, or Google Play. The current version of the app is being phased out as of July 1, 2024. To avoid any interruption of visit record keeping, you should now download the latest version of the app.
Please contact Provider Services with questions: