MaineCare Bulletins

Date Title Topic
Section 97, Private Non-Medical Institutions, (PNMI) Appendix E - Clinical Documentation for Continued Stay Reviews Behavioral Health (BH), Long Term Services and Supports
Updated Billing Guidance for Section 28 Providers Behavioral Health (BH), School Health Related Services
Quarter 1, 2025, Section 90 - Physician Drug Rates, CR 129556 Primary Care and Care Coordination
2025 Indian Health Services (IHS) Rate Update, CR 129495 Primary Care and Care Coordination
REVISED Section 90, Primary Care Provider (PCP) Rates Effective January 1, 2025, CR 129557 Primary Care and Care Coordination
Attention Providers: Update on Capping of MaineCare Payment Cycles Behavioral Health (BH), Dental Services, General, All Services, Hospital & Clinic Services, Long Term Care Services, Long Term Services and Supports, Primary Care and Care Coordination, Retail Pharmacies, School Health Related Services, Specialty Services
Attention Providers: AIDS Drug Assistance Program (ADAP) 101 Webinar Available General, All Services, Hospital, Family Planning, and Ambulatory Care/Clinic Services, Primary Care and Care Coordination
Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840 General, All Services
Prior Authorizations (PAs) for Certain Dental Services Dental Services
Attention Hospital Providers: Microdyn Update for Ambulatory Payment Classification (APC) & DRG Errors Hospital & Clinic Services
Interpreter Services – Rate Determination Kickoff Meeting General, All Services
Section 107 Psychiatric Residential Treatment Facilities (PRTF) Rate Determination - Public Comment Summary with Department Responses and Final Draft Rates Behavioral Health (BH)
MaineCare Hearing Aid Procurement Contract Coding Error Specialty Services
Primary Care Plus (PCPlus) Quality Webinar: Lead Screening in Children Primary Care and Care Coordination
MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities Not in use, State & Federal Policy
REVISED Medicare Standardization Rates Effective January 1, 2025: Sections 15, 75, & 95 - CRs 129368, 129491, 129354 Specialty Services
Section 97, Private Non-Medical Institutions, (PNMI) Appendix D, Temporary High Intensity Services Rate Determination: Presented Materials and Comment Deadline Behavioral Health (BH)
Correction to MaineCare Dental Metrics Reporting Dental Services
MaineCare Rate Reform Expert Technical Advisory Panel (TAP) Consultation on Draft CY2025 Rate Determination Schedule General, All Services
Attention Nursing Facility (NF) Administrators and Directors of Nursing: NF Quality Partnership Call Related to Quality Payment in the New NF Rate Model Long Term Care Services
Payment Error Rate Measurement (PERM) Reporting Year (RY) 2024 Errors General, All Services
Disclosures of Organizational Change Reminder General, All Services
Attention Providers: Update on FY25 Supplemental Budget Behavioral Health (BH), Dental Services, General, All Services, Hospital, Family Planning, and Ambulatory Care/Clinic Services, Hospital & Clinic Services, Long Term Care Services, Long Term Services and Supports, Not in use, Not in use, Primary Care and Care Coordination, Retail Pharmacies, School Health Related Services, Specialty Services
Attention Providers: Potential Capping of MaineCare Payment Cycles Behavioral Health (BH), Dental Services, Hospital, Family Planning, and Ambulatory Care/Clinic Services, Hospital & Clinic Services, Long Term Care Services, Long Term Services and Supports, Not in use, Not in use, Not in use, Primary Care and Care Coordination, Retail Pharmacies, School Health Related Services, Specialty Services, State & Federal Policy
340B Modifier Billing Reminder Extension – CR 129740 Hospital & Clinic Services
Residential Private Non-Medical Institution (PNMI) Appendix C Updated Rates for 2025 Long Term Care Services
Attention Providers: Potential Capping of MaineCare Payment Cycles General, All Services
Attention Providers: AIDS Drug Assistance Program (ADAP) 101 Webinar Available General, All Services
Survey for Providers of Personal Care and Home Health Services: Home and Community Based Services (HCBS) & Access Rule Long Term Services and Supports
MaineCare Notice of Agency Waiver Renewal, MaineCare Benefits Manual, Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder Not in use, State & Federal Policy
Section 67, Nursing Facility (NF) Providers MAY NOW SUBMIT JANUARY CLAIMS Long Term Care Services
Providers of Section 17 Services – Telehealth Clarification Behavioral Health (BH)
Attention Section 67, Nursing Facility (NF) Providers: Implementation of NF Reform Billing Changes Long Term Services and Supports
Training Opportunity Available for Family and Caregivers of Adults Receiving Services Within Section 12, 19, and 96 Programs Long Term Services and Supports
MaineCare Notice of Agency Emergency Rule-making Adoption, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities Not in use, State & Federal Policy
Section 5, Ambulance Services January 1, 2025, Rate Update - CR 129313 Specialty Services
Attention MaineCare Providers: MaineCare Operations are Continuing as Normal at this Time General, All Services
Public Forum Cancelation: Home and Community Based Service (HCBS) Providers of Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology & Personal Support Services Long Term Services and Supports
Certified Community Behavioral Health Clinics (CCBHC) Demonstration Comment Summary with Department Response Behavioral Health (BH)
Section 65 Behavioral Health Clarification of Authorization Requests for MAT/Suboxone & Medication Management Behavioral Health (BH)
Rate Determination Initiation Notice and Public Forum for Section 97, Private Non-Medical Institutions (PNMI) Appendix D, Temporary High Intensity Services Behavioral Health (BH)
Home and Community Based Service (HCBS) Providers of Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology & Personal Support Services: Draft Rate Public Review and Comment Long Term Services and Supports
Calendar Year (CY) 2025 Rate Determination Schedule General, All Services
Correction to Section 67, Nursing Facility Rate Letters Published on January 16, 2025 Long Term Care Services
Attention Providers of Section 21 Agency Home Support: Information About Staffing Thresholds Long Term Services and Supports
Correction to ​Hospital Outlier Payment Methodology, CR 128941 Hospital, Family Planning, and Ambulatory Care/Clinic Services, Hospital & Clinic Services
Update to Electronic Visit Verification (EVV) Missing Clients in Sandata General, All Services
Revision of Medicare Standardization Rates General, All Services
Nursing Facilities (NFs) and Residential Care Facilities (RCFs), PNMI, Appendix C Rate Letters Long Term Care Services
Final Draft Rates for Certain Medicare Covered Family Planning Services and Long-Acting Reversible Contraception (LARCs): Sections 14, 30, 31, 45, 90 & 103 Hospital & Clinic Services, Primary Care and Care Coordination