Update to the Biosimilar Preferred Drug List (PDL)
Effective January 1, 2025, the Department will add preferred and non-preferred drugs to the Biosimilar PDL, listed below.
Preferred drugs:
- Q5108 – Fulphila, pegfilgrastim-jmdb
Non-preferred drugs:
Attention Pharmacy Providers Under Title 5
Pharmacy providers whose pharmacy license is under a Title 5 review may use your Title 5 notice to extend your enrollment with MaineCare in MIHMS by six months, and for every six months thereafter, until the Title 5 review is resolved.
Rate Determination Initiation Notice for Section 80, Pharmacy Services : Dispensing Fees
The Department has initiated a Rate Determination Process for Dispensing Fees under Section 80 of the MaineCare Benefits Manual.* Maine, along with several other New England states (CT, VT, NH, RI), are participating in an initiative through New England States Consortium Systems Organization (NESCSO) to develop a reimbursement methodology for pharmacy dispensing fees. NESCSO is a non-profit organization governed by the New England State Health and Human Services agencies and the University of Massachusetts Medical School.
Section 67, Nursing Facility (NF) Services - Final Draft Rates and Methodologies Comment Summary
An updated summary of all comments resulting from both the March and October 2024 forums is available on the MaineCare Rate System Reform webpage.
Retro Physician Drug Rate Updates: Effective October 1, 2023, through September 30, 2024, CR 127535
The Department updated multiple physician drug codes retroactively due to a rate update from the Centers for Medicare & Medicaid Services’ (CMS). These new rates were implemented on October 23, 2024.
See the table below for the effective dates and new rates.
|
Procedure Code |
Start Date |
End Date |
Current Rate |
Revised Rate |
Quarterly Physician Drug Code Update: Quarter 4, CR 128318
Effective October 1, 2024, in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, the Department retroactively updated the Physician Drug Rates. On November 20, 2024, the new rates were implemented for billing, and we then processed claims submitted on or after November 20, 2024, at the new rates.
Seasonal Flu Codes Added for Hospitals, CR 127605
Effective August 1, 2024, MaineCare updated the seasonal flu codes and rates for hospitals in alignment with the Centers for Medicaid Services (CMS). The new codes are now available for billing. No provider action is required as we will reprocess claims that denied in error.
See the notice from September 6, 2024, for the seasonal flu codes.
SNAP 236A - FFY25 Budgeting Figures
10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules -Section 999-3
Rule #236A – FFY25 Budgeting Figures
SNAP Rule #234A - ABAWD Geographic Exemptions
10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules - Section 999-2
SNAP Rule #234A – ABAWD Geographic Exemptions
Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment
Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment
AGENCY: Department of Health and Human Services, Office of MaineCare Services
NATURE OF PROPOSED CHANGES: The state is requesting a budget neutrality projection adjustment for two components of the current 1115 Waiver Substance Use Disorder (SUD) Care Initiative.