DHHS → node
As previously announced in September of 2024, MaineCare removed all documented add-on amounts associated with the service provider tax for MaineCare reimbursements, effective January 1, 2025.
The codes and modifiers listed in the table below for sections 18 and 20 are now updated to reflect this rate change and no provider action is needed.
MaineCare updated multiple codes and rates retroactively due to a rate update from the Centers for Medicare & Medicaid Services (CMS). The new rates are effective April 1, 2024, through March 31, 2025.
See the table of affected codes below for the effective dates and new rates.
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Procedure Code |
Start Date |
End Date |
Previous Rate |
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Apr 4, 2025
Quality, Excellence, Staffing, and Teamwork (QuEST) are key to improving value for Maine’s nursing home residents.
Our earlier notice incorrectly listed Section 19, as included in the bulleted materials. Please see the corrected information below.
On April 14, 2025, the Department with its vendor, Burns and Associates, which is a division of Health Management Associates (HMA-Burns), held an online public meeting to present the recommended draft rates and rate models in addition to rationale for Sections 18, 20, 21, 29, and the new Lifespan waiver.
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
On April 14, 2025, the Department with its vendor, Burns and Associates, which is a division of Health Management Associates (HMA-Burns), held an online public meeting to present the recommended draft rates and rate models in addition to rationale for Sections 18, 20, 21, 29, and the new Lifespan waiver.
The following presented materials are available on the *HMA-Burns webpage:
Recording of April 14, 2025, Public Forum
A new e-message list for critical information
MaineCare created a new e-message topic list called MaineCare - Critical Communications. We will utilize this list solely to share information when circumstances disrupt provider operations. Since you are already subscribed to at least one topic, we will upload your email address and add it to this new listserv option.
Examples of critical information we will send via the new critical topic list include, but are not limited to:
We are pleased to announce that the PCPlus application period is now open! The application is open until Friday, May 2, 2025.
PCPlus is a MaineCare primary care model that gives Primary Care Providers (PCPs) greater flexibility and incentives to meet MaineCare members’ healthcare needs by transitioning away from a volume-based (fee-for-service) payment system toward population-based payments tied to cost and quality-related outcomes. Participation in PCPlus is voluntary for PCPs, and PCPs must apply to participate.
Two Types of PCPlus Aplications
AUGUSTA-- The Maine Center for Disease Control and Prevention (Maine CDC) is encouraging Maine residents to stay safe while traveling this spring. Travel and vacations can promote physical and mental well-being. That said, with school and other spring vacations occurring amid ongoing outbreaks of measles in the U.S., and mosquito-borne diseases like dengue in the Caribbean, and in Central and South America, travelers should plan ahead and take steps to stay healthy, whether traveling in the U.S. or abroad.