• Read more about Missing Clients in Sandata

Some providers responsible for Electronic Visit Verification (EVV) may experience issues with missing clients who are approved for services. This may impact the ability to create visit records and submit claims for visits. If you experience this issue, and have not reported it, please contact Provider Services at: 1-866-690-5585.   

We appreciate your patience during this time and understand the impact it may have on your operations. We are working with Sandata to resolve the issue as quickly as possible and will send another notice once it’s resolved. 

• Read more about TANF Rule #122A - Mileage Reimbursement Update

10-144 C.M.R. Ch. 331; Public Assistance Manual

Temporary Assistance for Needy Families

(TANF) Manual

Chapter V

TANF Rule #122A – Mileage Reimbursement Update

• Read more about Section 50, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) Rate Letters for Calendar Year (CY) 2025

Rate Letters 

The CY 2025, ICF-IID rate letters are now available on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.  

If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585. 

For questions about the content of the letters, please contact Rate Setting directly by using the contact listed on the letters.

• Read more about Reminder for all Providers: A 30-Day Notice is Required Prior to Closure

All MaineCare enrolled providers are requirement to provide at least a 30-day notice to the Office of MaineCare Services (OMS) if they are closing one of their programs or their agency. This requirement is listed in the MaineCare Benefits Manual (MBM) Chapter I Section 1.03-6.

• Read more about Section 40, Home Health Services: Reimbursing Parents Providing Home Health Aide (HHA) Services

The Office of MaineCare Services (OMS) provides the following guidance to service providers and interested parties in accordance with LD 346, which requires OMS to reimburse parents providing Home Health Aide (HHA) services to eligible minor children under MaineCare Benefits Manual (MBM), Section 40, Home Health Services.

• Read more about Section 97, Private Non-Medical Institutions (PNMI) Appendices E & F: Rate Letter Update

Effective January 1, 2025, the Department updated the rates for Section 97, Appendices E & F, to remove the Service Provider Tax (SPT).

Rate letters are accessible on the secure Health PAS Online Portal. To view them, log into your Trading Partner Account and follow this pathway: File Exchange > Reports > Rate Setting Letters.       

Jan 1, 2025

The following is a broad overview of some of the General Fund investments outlined in the Governor's FY26-27 biennial budget and the cost-saving measures proposed through the Department of Health and Human Services (DHHS) budget.

• Read more about Overview of DHHS Investments & Adjustments in FY26-27 Biennial Budget Proposal

• Read more about ​​Section 28: Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Claim Denials, CR 129350​

MaineCare has identified some Section 28 claim lines submitted with service code H2021 that denied for Benefit Restriction Group Validation Failed due to a system error. This error has been corrected. We will reprocess the affected claims. No action is required by providers.  

The Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) are as follows.  

• CARC 96: Non-covered charge(s).  

• RARC N130: Consult plan benefit documents/guidelines for information about restrictions for this service.  

• Read more about Nursing Facilities (NF): January Claims Hold and Navigating Rate Reform Billing Changes

Request to Hold January 2025 Claims

The Department is working to implement billing changes reflecting NF rate reform presented at the October 23, 2024 public forum and we expect these changes to be operational by February 1, 2025.

Please hold claims for services delivered in January 2025 until these changes are implemented and announced in a future notice. 

• Read more about Psychiatric Residential Treatment Facilities (PRTFs) Revised Draft Rates: Presented Materials & Comment Deadline

On January 9, 2025, the Department held an online public meeting to present revisions to the previously proposed Section 107, PRTF rates and model. Interested parties had the opportunity to provide public comments.