• Read more about 2022 Rate Update for Section 26 Day Health Services, CR 110465

Effective July 1, 2022, the rate for Section 26, Chapter III, Day Health Services (S5100 HC – Day Care Services)  increased from $3.86 to $3.99 per unit. The increase is based on 3.38 percent inflation   

• Read more about Section 60 DME Cures Act Codes, CR 109579 

Effective May 13, 2022, MaineCare Benefits Manual (MBM), Section 60, Durable Medical Equipment (DME) codes have been updated in MIHMS retroactively to January 1, 2022.

Jul 7, 2022

In the wake of the Supreme Court striking down Roe v. Wade, Governor Janet Mills has signed an Executive Order to further safeguard access to abortion in Maine and to protect Maine health care providers who provide reproductive health care and their patients. 

• Read more about Access to Abortion Care in Maine

• Read more about MaineCare Pediatric COVID-19 Vaccine Administration and Vaccine Counseling: Please Hold Claims Pending Further Billing Guidance

Effective June 17, 2022, the Food and Drug Administration authorized emergency use of the Moderna and Pfizer-BioNTech vaccines for the prevention of COVID-19 to include children as young as 6 months.  &n

• Read more about New MaineCare Coverage for Federally Non-Qualified Children Under 21 and Pregnant People 

Per P.L. 2021, Ch. 398 and P.L. 2021, Ch.

• Read more about Updated Payment Rate Details for Substance Use Disorder (SUD) Intensive Outpatient Program (IOP) Service Providers, CR 110559 

Effective June 29, 2022, we have updated the rate for Sections 65, Substance Use Disorder (SUD) Intensive Outpatient Program (IOP) services in MIHMS retroactively to January 1, 2022. These rates are now ready to bill.

• Read more about Primary Care Plus (PCPlus) Orientation Events 

PCPlus is MaineCare’s new value-based approach to support the primary care system, improve healthcare quality, and reduce inefficient health care spending. PCPlus gives primary care providers greater flexibility and incentives to meet MaineCare members’ healthcare needs.  

Over 230 primary care practices are expected to participate in PCPlus starting July 1, 2022. Participation includes: 

• Read more about Dental Prior Authorization (PA) Forms, CR 110373 

Effective July 1, 2022, we have updated the Prior Authorization (PA) process for dental services. We have updated some dental PA forms. Please see below for more information about the changes that are in effect on July 1, 2022.

Please discontinue use of these forms:

• Dentures PCP PA Form
• Supplemental Denture PA Form

Please use the following new forms:

• Read more about UPDATE for Providers Billing on UB-04 and 837I Claims, CR 107682 

Effective August 31, 2022, UB-04 and 837I claims submitted without an attending provider will be denied. 

• Read more about MaineCare Benefits Manual, Chapter II, Section 25, Dental Services (repeal); Chapter III, Section 25, Allowances for Dental Services (repeal); Chapter II, Section 25, Dental Services and Reimbursement Methodology (rule replaces the two repealed rules)