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10-144 C.M.R. Ch. 332; MaineCare Eligibility Manual – Part 9: LIMITED BENEFITS GROUP and Chart 3.8: Premiums for Special Benefits Waiver [Maine Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS]
Rule #312A – Part 9 and Chart 3.8 Premium Updates
Effective January 1, 2025, MaineCare updated DME rates benchmarked to Medicare, to reflect 100% of current year Medicare rates. You may view the new rates on the Rate Setting page of the Health PAS Online Portal.
The Department is extending the deadline for written comments on the HCBS Sections 18, 20, 21, 29 and New Lifespan Waiver rate determination to May 6, 2025. Please see the presented materials notice that followed the forum for more information.
Please submit comments to our vendor HMA – Burns: OADSRateStudy@healthmanagement.com
Following two years of discussions with interested parties, we implemented a new approach to MaineCare NF payments for 2025. Phase I of NF rate reform establishes a new pricing model for general care in NFs.
The Beneficiary Advisory Council (BAC) is a dedicated group of individuals with lived experience who help shape access to quality healthcare, policies, and MaineCare services across the state.
We believe that the best solutions come from those directly impacted by Medicaid - whether as recipients, family members, or caregivers.
MaineCare is excited to announce the rebrand of the EPSDT program.
The program is now called VitalCare for Kids!
VitalCare for Kids will maintain the national standards of care federally required under EPSDT to ensure children get the health care they need when they need it – the right care, to the right child, at the right time, in the right setting.
The Department adopted the amended 10-144 CMR Chapter 708, Rules Relating to the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Maine, for consistency with concurrent adoption of 10-144 CMR Chapter 707, effectively implementing expanded coverage under the Maine Center for Disease Control and Prevention - Breast and Cervical Health Program (MBCHP). The adopted amendments to Chapter 708 are consistent with the proposed non-substantive changes that include a revised rule format and language for conformity with agency standards.
The Department adopted amendments to 10-144 CMR Ch. 707, Rules Relating to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Maine to expand coverage and eligibility for the Maine CDC Breast and Cervical Health Program (MBCHP) to include qualifying participants who are 21 to 34 years old and the addition of human papillomavirus (HPV) testing as another service in rule that MBCHP will cover when determined medically necessary and provided by a participating MBCHP Provider.
Effective January 1, 2025, MaineCare updated the rates for Section 55, Laboratory Services. The new rates were implemented for billing on February 26, 2025. You may view the updated fee schedule on the Rate Setting page of the Health PAS Online Portal.
The new criteria sheet NFs Bariatric Care is available by logging into your Trading Partner Account in the secure section of the Health PAS Online Portal. Once logged in, please follow this pathway: MaineCare Information > Prior Authorizations > Manual, Forms, and Criteria Sheets > Policy Section 67, NF Services.
If you have questions, please email Provider Services or call 1-866-690-5585. TTY users dial 711.