Updated Guidance for Continued Stay Reviews (CSR) in Section 97 Private Non-Medical Institution (PNMI) Appendix E

As previously communicated in the Department’s March 4, 2025, notice, PNMI Appendix E providers are required to submit clinical documentation supporting medical necessity every 90 days as part of each member’s CSR.

Required Documentation

Clinical documentation must be submitted through the Atrezzo system and must include the following member-specific information:

Payment Error Rate Measurement (PERM) Reporting Year (RY) 2024 Errors

All errors found during a PERM audit are considered improper payments. Maine is required to reimburse the federal government for all improper payments and has the right to seek recoupment from providers for improper payments resulting from provider error.

The most common errors found in the RY 2024 PERM Audit cycle are listed below. The most common errors from the previous two PERM cycles are also included in the list. Before submitting a claim, check that the information for the member and the services provided are accurate and complete.

Maine CDC Shares Tips to Prevent Getting Rabies from Bats

AUGUSTA-- The Maine Center for Disease Control and Prevention (Maine CDC) urges Maine residents and visitors to take steps to prevent rabies exposure by limiting contact with bats. Bats are most active in Maine from midsummer to early September, though bat exposures can happen at any time of year. The Maine CDC encourages people to be cautious around bats, keep a safe distance, and know what to do after exposure to a bat.

Celebrating 60 Years of Medicaid: MaineCare's Impact on Maine

Jul 7, 2025

What is Medicaid?

Medicaid provides free or low-cost health insurance and other health benefits to people who qualify based on income and household size, disability, age, and/or citizenship status. The program is jointly funded by the federal and state governments. In Maine, we call our Medicaid program "MaineCare."

July 30, 2025, marked the 60th anniversary of Medicaid, which was signed into law by President Lyndon B. Johnson in 1965. This milestone offers an opportunity to reflect on Medicaid’s key achievements and its impact on Maine over the past six decades.

Maine CDC Identifies First West Nile and Powassan Virus Cases of the Season

Maine people and visitors urged to take precautions against tick and mosquito bites

AUGUSTA-- The Maine Center for Disease Control and Prevention (Maine CDC) announced the first human case of Powassan virus infection and the first wild bird case of West Nile virus (WNV) infection this year. An adult resident of Hancock County infected with Powassan virus developed neurologic symptoms and was hospitalized. The crow with WNV was discovered in York County.

MaineCare Benefits Manual (MBM), Chapter VI, Section 3, Primary Care Plus (PCPlus) – Rate Determination Kickoff Meeting & Primary Care Utilization Review Meeting

On August 4, 2025, the Department will host a kick-off meeting to introduce the next phase of MaineCare’s PCPlus reform work, and to receive feedback on your experiences and insights from participating in the PCPlus model. This is an important step to shape the next phase of the PCPlus Alternative Payment Model (APM). This meeting was originally scheduled for July 16, 2025, but we  postponed it due to technical difficulties.

RESCHEDULED: Primary Care Plus (PCPlus) Model Advancement Kickoff Meeting and PCPlus Phase II Alternative Payment Model (APM) Design Kick-off Meeting

Please join us on Monday, August 4, 2025, to learn about the next phase of MaineCare’s PCPlus reform work. This session will be an opportunity for practices to provide feedback on your experiences and insights as you participate in the PCPlus model. Your input will help shape the next phase of the PCPlus APM. 

PCPlus Model Advancement Kick-off Meeting:

Discussion Topics:

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