• Read more about REVISED Medicare Standardization Rates Effective January 1, 2025: Sections 15, 75, & 95 - CRs 129368, 129491, 129354

MaineCare made updates to Section 15, 75, and 95, Medicare covered codes and rates to align with recent revisions made by the Centers for Medicare and Medicaid Services (CMS). These new rates now reflect 72.4% of the most recent 2025 Medicare rates.

Rates were implemented on the dates listed in the table below, for the following sections:

• Read more about Section 97, Private Non-Medical Institutions, (PNMI) Appendix D, Temporary High Intensity Services Rate Determination: Presented Materials and Comment Deadline

On February 14, 2025, MaineCare held an online public meeting to present draft rates and models along with the rationale for PNMI, Appendix D, Temporary High Intensity Services. Interested parties had the opportunity to provide public comments.

• Read more about Correction to MaineCare Dental Metrics Reporting

MaineCare identified and corrected an error in the MaineCare Dental Metrics reporting. 

Due to a data filtering error, previous publications of the MaineCare Dental Metrics Report excluded rendering providers in instances where the billing provider is also the rendering provider on the claim, resulting in understated counts of dental rendering providers.

• Read more about MaineCare Rate Reform Expert Technical Advisory Panel (TAP) Consultation on Draft CY2025 Rate Determination Schedule

Pursuant to Rate Reform law (MRS Title 22, 3173-J), MaineCare will host our Annual Draft Rate Determination Schedule Consultation with the TAP on March 14, 2025, from 1:00 PM to 2:30 PM via Zoom. This meeting is open to the public. There will be a limited period of time at the end of the meeting for public comment. 

Zoom Meeting

https://mainestate.zoom.us/j/84867322771

• Read more about Attention Nursing Facility (NF) Administrators and Directors of Nursing: NF Quality Partnership Call Related to Quality Payment in the New NF Rate Model

• Read more about MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities

Notice of Agency Rule-making Proposal

AGENCY: Department of Health and Human Services (DHHS), Office of MaineCare Services, Division of Policy

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities

PROPOSED RULE NUMBER:

CONCISE SUMMARY:

• Read more about Attention Providers: Update on FY25 Supplemental Budget

On February 10, 2025, we shared that, if the Legislature does not pass the Fiscal Year 2025 supplemental budget request to fill the MaineCare shortfall, the Department will not have sufficient funds to pay MaineCare providers in full through the end of the fiscal year and will need to temporarily withhold

• Read more about Disclosures of Organizational Change Reminder

If your organization is going through an organizational change, please contact Gainwell to receive guidance before beginning an enrollment/revalidation/re-enrollment application or maintenance case and prior to submitting the Disclosure of Organizational Change for MaineCare form. This allows Gainwell/MaineCare to review the change and decide what is the best way the provider needs to enroll or update their enrollment.

Please contact the MaineCare Enrollment email box with questions.  

• Read more about Payment Error Rate Measurement (PERM) Reporting Year (RY) 2024 Errors

All errors found during a PERM audit are considered improper payments.Maine is required to reimburse the federal government for all improper payments and has the right to seek recoupment from providers for improper payments resulting from provider error.

The most common errors found in the RY 2024 PERM Audit cycle are listed below. The most common errors from the previous two PERM cycles are also included in the list. Before submitting a claim, check that the information for the member and the services provided are accurate and complete.

• Read more about Attention Providers: Potential Capping of MaineCare Payment Cycles

It has come to our attention that not everyone who signed up for e-messages are receiving the notices we send through the General, All Services distribution list. We are working to resolve this issue. In the meantime, we are resending the e-message we sent on February 10, 2025.