Aug 8, 2024

Maine's Medicaid program (MaineCare) is in the midst of significant changes that make it more important than ever to keep Maine people covered for health care. Following the end of the COVID-19 Public Health Emergency, updates to federal rules mean that every Mainer who has coverage through MaineCare will have their coverage reviewed to ensure they are still eligible -- this process is known as the "unwinding" of the continuous Medicaid eligibility requirement. This process started in April 2023, and eligibility redeterminations will be completed by October 31, 2024.

• Read more about Maine DHHS releases new analysis to inform outreach as final phase of MaineCare "unwinding" approaches

• Read more about 10-149 C.M.R. Ch. 5, Sec. 2; DEVELOPMENTAL DISABILITY SERVICES FOR ADULTS WITH AN INTELLECTUAL DISABILITY OR AUTISM SPECTRUM DISORDER

The purpose of the rulemaking is to clarify the application process for Developmental Services available at OADS that are supported exclusively with state funds. The rule also removes descriptions of internal agency processes regarding client intake and eligibility determination, updates the tests for determining whether an applicant has an intellectual disability (abandoning the harmful terminology of years past) and Autism Spectrum Disorder, and identifies the state-funded Developmental Disability Services available from OADS. 

• Read more about CORRECTION: Implementation Date of Section 92, Behavioral Health Homes (BHH) Retroactive COLA, CR 125416

The previous e-message announcing the implementation of COLAs for Section 92, BHH, has been corrected to display the accurate effective date of December 21, 2023.

• Read more about Rate Determination Kickoff Meeting: Sections 12, 18, 19, 20, 21, 29, 40, 96, & 102, Home & Community Based Services (HCBS) Providers of Clinical, Therapy, Care Coordination, Supportive Skills Building, & Assistive Technology Services

Earlier this year, MaineCare provided notice that it had initiated a rate determination process for certain HCBS services provided under Sections 12, 18, 19, 20, 21, 29, 40, 96, & 102, of the MaineCare Benefits Manual (MBM).   

• Read more about Section 92, Behavioral Health Homes (BHH): Implementation of Cost-of-Living Adjustments (COLAs) Effective December 21, 2023, CR 125416

As previously noticed on December 1, 2023, MaineCare is increasing reimbursement for Section 92 BHH services through a 2.54% COLA. The implementation of this COLA had been “pending approval of appropriations.”

• Read more about Sections 2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024

On December 1, 2023, MaineCare provided notice that it would increase reimbursement for certain eligible services through a 2.54% COLA, to be effective January 1, 2024. The notice indicated a status of “pending approval of appropriations” for several eligible services (under Sections 2, 13, 17, 26, 28, and 65).

• Read more about Attention Pharmacy Providers: Status of Restoration of Maine Point of Purchase System (MEPOPS) and Office Hours with MaineCare’s Pharmacy Team

The Office of MaineCare Services continues a phased recovery following the outage that occurred from February 21, 2024, through March 26, 2024, due to the national cyber security issue affecting Change Healthcare. 

We are entering the next phase of the recovery and are continuing to restore waived edits. On May 1, 2024, Reject – 79 Refill Too Soon and Reject-79 Refill Too Soon Carryover were returned to normal functioning. On July 17, 2024, Reject-76 Plan Limitations Exceeded, returned to normal functioning.   

• Read more about Attention MaineCare Providers: Notice of Returning Pharmacy Processes Including Prior Authorizations

The Office of MaineCare Services continues a phased recovery following the outage that occurred from February 21, 2024, through March 26, 2024, due to the national cyber security issue affecting Change Healthcare. 

During the outage, limitations were waived regarding medications that were refilled too soon. On May 1, 2024, Reject–79 Refill Too Soon and Reject-79 Refill Too Soon Carryover were returned to normal functioning.  

• Read more about Skin Substitutes no Longer Require a Prior Authorization (PA) - CR 126315

Effective August 1, 2024, skin substitute products no longer require a PA. Providers are expected to select the most appropriate product for treatment and to use the products for the purposes for which they have FDA approval. 

For questions, please contact your Provider Relations Specialist.  

• Read more about Health PAS Online Portal – New: Member Renewal Date Now Available, CR 119276

In July 2024, MaineCare updated the Health PAS Online Portal to include the member’s renewal date, when available, so that providers can more accurately assess the status of a member’s eligibility. Please note the following updates about the eligibility renewal date field:  The new field shows the renewal date of members whose date has been finalized.