• Read more about Home and Community Based Settings (HCBS) Lifespan Project Listening Sessions 

Please join the Department of Health and Human Services’ Office of Aging and Disability Services (OADS), Office of Child and Family Services (OCFS), and Office of MaineCare Services (OMS) for a presentation and listening session on a proposed Lifespan Project for individuals with Intellectual and Developmental Disabilities (IDD).   

• Read more about ATTENTION Correction to Section 92, Section 13, and Section 17 message to Providers: Passthrough process now required if organizations jointly serve an Opioid Health Home (OHH) Member   

This is a correction to the e-message sent on September 2, 2022, regarding Passthrough Payments for certain services. The message incorrectly stated that Opioid Health Homes (OHH) providers will need to enter authorizations codes for case management services provided by Section 92, Section 13, and Section 17 providers through Kepro.

• Read more about 835 and RA Delays

835 and Remittance Advice (RA) processing is delayed. We are working to correct the issue as quickly as possible. We apologize for the inconvenience.

• Read more about Re-entry Update #11

Good morning,

We are now in the fourth phase of the Department’s re-entry process, which is about preparation. This includes preparing offices to have more workers in them.

To that end, we are moving ahead with the installation of sit-stand desks in offices. We expect many of them will be installed by September. We are working on the schedule to install the remainder in early fall. We hope you enjoy them.

• Read more about CLARIFICATION regarding Sections 13, 17, 28, 65, 92 Draft Rate Model(s) Public Review and Comment message

This message is to clarify an announcement last week regarding three online public meetings MaineCare is holding the week of September 19 to present draft rate models for Sections 13, 17, 28, 65, and 92.

• Read more about Pfizer and Moderna Bivalent COVID-19 Vaccines Authorized to use as Booster Doses

In an August 31, 2022, announcement, the Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUA) for the use of Bivalent COVID-19 Vaccines from Pfizer BioN-Tech and Moderna as a Booster Dose.

• Read more about Tribal Self-Attestation, CR 108474 

Effective August 26, 2022, the Department is now allowing MaineCare members to self-attest to being members of federally recognized tribes for the purpose of waving copayments and premiums.  

• Read more about ATTENTION Section 92, Section 13, and Section 17 Providers: Passthrough process now required if organizations jointly serve an Opioid Health Home (OHH) Member   

Please see changes below that apply when a Section 92 Behavioral Health Home, Section 13 Targeted Case Management, or Section 17 Community Integration provider delivers services to members enrolled with an Opioid Health Home (OHH). 

• Read more about Attention Providers of Sections 13, 17, 28, 65, 92 Draft Rate Model(s) Public Review and Comment

Earlier this year MaineCare conducted a survey of Behavioral Health and Other Services providers. We used the provider responses to create draft rate models for the services as part of the rate determination process. We outlined this process in a bulletin on April 22, 2022. This message outlines the next step in the process.

PUBLIC REVIEW AND COMMENT

• Read more about Division of Audit Appeal Decisions

Note: The first step in the appeal process is an informal review by the Division of Audit. Those decisions are posted here. The next step in the appeal process would be an administrative hearing before the Hearings Unit. The Recommended and Final Hearing Decisions are available at the Administrative Hearings Unit’s Provider Appeal Decisions’ section of their webpage.