• Read more about Section 45, Hospital Inpatient Psychiatric and Substance Use Disorder (SUD) Unit Services – Rate Determination Comment Summary with Department Response

In October of 2022, the Department’s Office of MaineCare Services initiated a rate determination process for Section 45, Inpatient Psychiatric and SUD units. On January 12, 2023, we held a virtual public forum with our vendor Burns & Associates (HMA – Burns), to present draft rate models and methodologies to interested parties and allow for public comment. Written comments were accepted through February 3, 2023.

• Read more about New Health Home Model for Substance Use Disorders (SUDs) –Rate Study Kickoff Meeting: Presented Materials

On May 7, 2024, MaineCare held a virtual public meeting with interested parties to present the major elements of the new SUD Health Home model and describe the process and timeline for this rate study. Participants had the opportunity to ask questions and provide feedback.

• Read more about Apply to Present at the 2024 MaineCare Delivery System Reform Forums

MaineCare’s Delivery System Reform (DSR) Annual Forums will be held on:

• September 16, 2024, in Auburn, ME
• September 24, 2024, in Orono, ME

This year, MaineCare is turning the tables and wants to hear from YOU! Consider applying to be a presenter.

May 5, 2024

The Department of Health and Human Services (DHHS) continues to make progress on key priorities and efforts to implement the numerous laws and initiatives advanced by the 131st Legislature as it approaches adjournment.

• Read more about Maine Takes Further Action to Improve Child Welfare System

• Read more about Webinar: What Primary Care Providers Need to Know About HIV

Maine was in the news recently for leading the nation in diagnosing HIV at late stage. To help primary care providers learn about HIV and AIDS, MaineCare is hosting a webinar, What Primary Care Providers Need to Know About HIV, on May 9, 2024, at 11:30 AM. This 30-minute free webinar will be led by Dr.

• Read more about Governor Mills Announces Health and Human Services Commissioner Jeanne Lambrew to Step Down at End of May

Under Lambrew’s leadership, Maine expanded affordable health care to more than 100,000 people, led the nation in COVID-19 response, made historic investments in health and human services, and rebuilt the Department

Governor Janet Mills announced today that Jeanne Lambrew, Ph.D., will step down from her position as Commissioner of the Department of Health and Human Services, effective May 31, 2024, to accept a position leading national health policy development and to teach at Harvard University.

• Read more about UPDATE - Claims Pending for Missing Vendor Code​

The Office of MaineCare Services (OMS), Office of the State Controller, and Gainwell have resolved the issues with claims going to a PEND status for a Missing Vendor Code (Edit 6037), that occurred twice last week. 

Please note that Gainwell is mass adjudicating all the claims affected and there should be no impact on next week’s payment. 

• Read more about Attention Pharmacy Providers: Updated Technical Instructions for Processing Backlogged Claims​

Pharmacy claims resumed processing on March 27, 2024. MaineCare continues to work with Optum to review outstanding rejected claims with dates of service during the system outage. The guidance below applies to claims with dates of service from February 21, 2024, through March 26, 2024.

• Read more about EVV Providers – Update to Latest Version of the Sandata Mobile Connect (SMC) App

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:  

• EVV email box  

• 1-866-690-5585, option 3.

• Read more about ​Utilizing the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program for Children and Youth​

The goal of the EPSDT program is to ensure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting. 

MaineCare’s EPSDT program allows MaineCare members under the age of 21 to receive 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 and/or mental health, and specialty services.