Attention Section 45, Hospital Services Providers
Pursuant to PL 2023, ch.
MaineCare implements new rate reforms supported by current services budget
Jun 6, 2023
While the Legislature considers budget proposals for future MaineCare reforms, the Department of Health and Human Services (DHHS) Office of MaineCare Services continues its implementation of payment rates already developed under the landmark law (P.L. 2022, Ch. 639 (PDF)). Specifically, the Office of MaineCare Services implemented reformed payment for Federally Qualified Health Centers effective March 1 and will implement an array of cost-of-living adjustments effective July 1.
Attention Behavioral Health and Targeted Case Management Providers - Behavioral Health and Targeted Case Management Supplemental Payment Reporting
As a follow-up to our June 21, 2022, e-message regarding Behavioral Health and Targeted Case Management supplemental payments for providers of:
Attention Section 45, Hospital Services: Rate Determination Initiation Notice
This bulletin provides notice that the Department has initiated a Rate Determination Process* for Hospital Services, with the exception of Distinct Psychiatric and Substance Use Disorder Unit services for which the Department recently completed a rate determination, under Section 45 of the MaineCare Benefits Manual.
CORRECTION: Attention Providers of Section 67 Nursing Facilities (NF) and Section 97, Residential Care Facilities (RCFs, PNMI Appendix C): Provider Rate Methodology Workgroup Presented Materials
MaineCare, and its vendor will host the 5th Rate Workgroups meeting on June 26, 2023. Presented materials will then be posted to the Rate System Reform webpage shortly after. Please watch for future notices.
Section 50, Intensive Care Facilities (ICF) Rate Letters for Fiscal Year (FY) 2024 Now Available
The FY 2024 Section 50 ICF rate letters are now available on the secure Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: Exchange > Reports > Rate Setting Letters.
Extended-Release Buprenorphine Clinical Use Criteria
In order to promote access to Sublocade, Extended Release Buprenorphine (XRB), MaineCare may engage in rulemaking. In the meantime, providers may bill the medical benefit for XRB without Prior Authorization (PA) if their documentation meets the criteria outlined below. The criteria will be available on the Preferred Drug List after the July 2023 update. Failure to meet these criteria could result in sanctions.
Roster Billing Hepatitis A Vaccination Codes – CR 116982
MaineCare added Hepatitis A vaccination codes to the Roster Billing code list. Roster Billing Specifications can be found here.
Maine Point of Purchase System (MEPOPS) Blackout Period
On June 28, 2023, at 8:00PM, MEPOPS will be unavailable for eight (8) hours, due to system maintenance. Pharmacy claims will not be adjudicated during this time. We apologize for any inconvenience this may cause.
If you have any questions regarding this blackout period, please call the Change Healthcare Provider Help Desk at 1-888-420-9711.
Coverage of Medications for Treatment of Opioid Use Disorder in Pregnancy
MaineCare covers brand name Suboxone film and generic buprenorphine/naloxone tablets as “Preferred” covered products for treatment of opioid use disorder (OUD) as they are the most cost-effective forms of treatment on the MaineCare Preferred Drug List (PDL). Providers may choose to prescribe buprenorphine/naloxone combination product or buprenorphine monotherapy for patients who are pregnant.