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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.
MaineCare made updates to Section 15, 75, and 95, Medicare covered codes and rates to align with recent revisions made by the Centers for Medicare and Medicaid Services (CMS). These new rates now reflect 72.4% of the most recent 2025 Medicare rates.
Rates were implemented on the dates listed in the table below, for the following sections:
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Section 15 |
Chiropractic Services |
2/5/2025 |
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Section 75 |
Vision Services |
On February 14, 2025, MaineCare held an online public meeting to present draft rates and models along with the rationale for PNMI, Appendix D, Temporary High Intensity Services. Interested parties had the opportunity to provide public comments.
MaineCare identified and corrected an error in the MaineCare Dental Metrics reporting.
Due to a data filtering error, previous publications of the MaineCare Dental Metrics Report excluded rendering providers in instances where the billing provider is also the rendering provider on the claim, resulting in understated counts of dental rendering providers.
Pursuant to Rate Reform law (MRS Title 22, 3173-J), MaineCare will host our Annual Draft Rate Determination Schedule Consultation with the TAP on March 14, 2025, from 1:00 PM to 2:30 PM via Zoom. This meeting is open to the public. There will be a limited period of time at the end of the meeting for public comment.
Zoom Meeting
The Department will host an important educational call via Zoom for NF Administrators, Directors of Nursing, and other key members of your Quality Assurance Performance Improvement (QAPI) team on February 19, 2025, from 1:00 - 2:30 PM. The meeting will address quality components of the new NF payment model.
You may register through Zoom.
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services (DHHS), Office of 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
PROPOSED RULE NUMBER:
CONCISE SUMMARY:
On February 10, 2025, we shared that, if the Legislature does not pass the Fiscal Year 2025 supplemental budget request to fill the MaineCare shortfall, the Department will not have sufficient funds to pay MaineCare providers in full through the end of the fiscal year and will need to temporarily withhold
If your organization is going through an organizational change, please contact Gainwell to receive guidance before beginning an enrollment/revalidation/re-enrollment application or maintenance case and prior to submitting the Disclosure of Organizational Change for MaineCare form. This allows Gainwell/MaineCare to review the change and decide what is the best way the provider needs to enroll or update their enrollment.
Please contact the MaineCare Enrollment email box with questions.
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.