Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 13, Targeted Case Management Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 13, Targeted Case Management Services

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Family Planning Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Family Planning Services

NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement of certain family planning services, effective July 1, 2024. These changes are as follows:

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 25, Dental Services and Reimbursement

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 25, Dental Services and Reimbursement

Non-Emergent - Emergency Department Claims Not Pricing Correctly

MaineCare discovered that some hospital non-emergency claims failed to price correctly and were overpaid. This occurred when there was more than one emergency room service on the claim, for claims submitted for Dates of Service from January 1, 2022, and March 31, 2024. MaineCare reimburses differently in cases where non emergent use of the emergency room is determined.

No provider action is required as MaineCare will re-process these claims.

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