• Read more about Attention Providers of Section 67 Nursing Facilities (NF) and Section 97, Residential Care Facilities (RCFs, PNMI Appendix C): Presented Materials from Provider Rate Methodology Workgroup

On January 12, 2023, MaineCare provided notice that we initiated a rate determination process for Section 67, Nursing Facilities and Section 97, Residential Care Facilities.

• Read more about Pfizer-BioNTech COVID-19 Bivalent Vaccine Booster Authorized for Use in Individuals Aged Six Months to Four Years

In a March 14, 2023 announcement, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the use of Bivalent COVID-19 Vaccines from

• Read more about Electronic Visit Verification (EVV) Trainings and Forums

The federal deadline to implement the EVV requirements for Home Health providers delivering services under Section 40 and Hospice providers delivering services under Section 43 happened January 1, 2023.  

We continue to offer weekly provider and aggregator trainings and forums. All trainings and forums are online via Microsoft Teams. 

• Read more about Attention Providers of Section 31, Federally Qualified Health Centers (FQHC): Draft Rate Model Public Review and Comment​ 

The Department and our rate setting vendor, Burns and Associates, A Division of Health Management Associates, are collaborating with interested stakeholders to perform a rebasing of rates for FQHCs pursuant to

• Read more about Reminder: Primary Care Plus (PCPlus) Providers - Screening, Brief Intervention and Referral to Treatment (SBIRT) Peer Sharing Webinar

MaineCare, in collaboration with the Maine Substance Use Disorder (SUD) Learning Community and Co-Occurring Collaborative Serving Maine (CCSME), is hosting a SBIRT Peer Sharing webinar for our Primary Care Plus (PCPlus) providers. This webinar is facilitated by Eric Haram, LADC, faculty from the ME SUD Learning Community. This is an opportunity for PCPlus providers to: 

• Read more about Attention Section 30, Family Planning Service Providers: Medicare Benchmark Adjustments for January 1, 2023

Effective January 1, 2023, the Department updated reimbursement rates for certain Medicare covered codes and services for section 30, Family Planning services.

• Read more about Add-on Rates for Providers Predominantly Delivering Family Planning Services

Effective July 1, 2022, the Department has implemented new add-on rates in MIHMS for certain Family Planning Services delivered by eligible providers, per Maine P.L. 2021, ch. 738 An Act To Protect the Reproductive Rights and Freedoms of Maine People. In alignment with this statute, only providers engaged primarily in the delivery of sexual and reproductive health care services, as described in 42 United States Code, Section 1396d(a)(4)(C) are eligible to bill for these add-on rates.  

• Read more about Primary Care Plus (PCPlus) Providers - Screening, Brief Intervention and Referral to Treatment (SBIRT) Peer Sharing Webinar

MaineCare, in collaboration with the Maine Substance Use Disorder (SUD) Learning Community and Co-Occurring Collaborative Serving Maine (CCSME), is hosting a SBIRT Peer Sharing webinar for our Primary Care Plus (PCPlus) providers. This webinar is facilitated by Eric Haram, LADC, faculty from the ME SUD Learning Community. This is an opportunity for PCPlus providers to: 

• Read more about Section 60 Medical Supplies and Durable Medical Equipment (DME), Billing Guidance and Corrections

Reimbursement Methodology Changes 

• Read more about Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840

This is a reminder that the attending provider is required on all UB-04 and 837I claims.  Effective April 1, 2023, MaineCare will deny UB-04 and 837I claims submitted without an enrolled attending provider.

The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).