Important Copayment Information: End of the American Rescue Plan Act (ARPA) Exemption on Copays

At the beginning of the COVID-19 pandemic, the federal government relaxed certain requirements to promote continued access to healthcare services for members enrolled in Medicaid. ARPA allows states to cover COVID-19 vaccination, testing, and treatment without member cost sharing through September 30, 2024.

Beginning on October 1, 2024, MaineCare will reinstate copayments (copays) which had been waived for certain services.  

Reinstated Copayments

Attention HCBS Providers of Supportive Skills Building Services for Sections 12, 18, 19, 20, 29, & 96: Interested Parties Engagement Session Presented Materials

As previously noticed, MaineCare and its vendor are hosting several engagement sessions with interested parties to obtain important feedback as part of the rate determination process that was initiated in June of 2024, for certain HCBS services. 

MaineCare Notice of Agency Rule-making Adoption, Chapter II, Section 25, Dental Services and Reimbursement Methodology

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.

MaineCare Notice of Agency Rule-making Adoption, Chapter II, Section 25, Dental Services and Reimbursement Methodology

Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE:  10-144 C.M.R, Chapter 101, Chapter II, Section 25, Dental Services and Reimbursement Methodology

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

Maine CDC Warns of Mosquito-Borne Virus Identified in Three Additional Counties

Maine people and visitors urged to protect themselves during high-risk mosquito season

AUGUSTA-- The Maine Center for Disease Control and Prevention (Maine CDC) announced today four wild birds tested positive for West Nile virus (WNV) in three new counties -- Piscataquis, Sagadahoc, and Washington. An alpaca also tested positive for WNV in Lincoln County, where a prior case of WNV was detected in a bird earlier this summer.

Microdyn Update for Ambulatory Payment Classifications (APC) - CRs 126318 & 126319

Effective September 14, 2024, the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates are complete in MIHMS. The following CMS documents provide the details of the APC updates:   

  • July 2024 Integrated Outpatient Code Editor Specs

https://www.cms.gov/files/document/r12666cp.pdf

  • July 2024 Update of Hospital Outpatient Prospective Payment System (OPPS)

https://www.cms.gov/files/document/r12665cp.pdf

Taxonomy Code Requested on Claim Submissions – Portal Claims

The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by  CMS to conduct program oversight, administration, and integrity.  

Children’s Behavioral Health & Residential Treatment

Applying for Children’s Residential Care Facility Services

OCFS contracts with KEPRO to manage Children’s Residential Care Facility Services (CRCF). Children’s Residential Care Facility Services for children follows the MaineCare Section 97 eligibility criteria. KEPRO processes all applications and completes Prior Authorizations for Children’s Residential Care Facility Services, and they are your contact related to approval for admissions to Children’s Residential Care Facility.

Rule Adoption: Amyotrophic Lateral Sclerosis Incidence Registry Rule; 10-144 CMR Chapter 175

The adoption of Maine’s Amyotrophic Lateral Sclerosis Incidence Registry Rule, a new rule administered by the Maine Center for Disease Control and Prevention, establishes data collection requirements and data release protocols specific to reportable cases of patients diagnosed with amyotrophic lateral sclerosis (ALS). For the purpose of the statewide ALS registry required by 22 MRS Sec.

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