• Read more about Updated Guidance for Power Mobility Devices (PMD), CR 124323

Medicare has updated the documentation guidelines on PMDs, which include Power Operated Vehicles (POV) and Power Operated Wheelchairs (POW). Until such a time as the MaineCare Benefits Manual (MBM), Section 60.08-8(C) is updated, the Prior Authorization (PA) department will review PA requests consistent with the updated requirements that will also be included in the PA criteria sheet located on the Health PAS online portal. Updated PA criteria includes:

• Read more about Rate Determination Initiation Notice for Home and Community Based Services (HCBS) Clinical, Therapy, Care Coordination, Supportive Skills Building, and Assistive Technology Services

This bulletin provides notice that the Department has initiated a Rate Determination Process* for certain HCBS services found in MaineCare Benefits Manual (MBM) Sections 12, 18, 19, 20, 21, 29, 40, 96, and 102 and is now conducting a rate study. Public Consulting Group will be conducting this rate study. MaineCare will provide a list of service categories to be reviewed once the Department's contracted vendor performs a code analysis of the sections.  

• Read more about EVV Providers – Update to Latest Version of the Sandata Mobile Connect (SMC) App

EVV Providers who are currently using the SMC app through their phone, tablet, or other mobile device should update to the latest version of the app using the Apple Store, or Google Play. The current version of the app is being phased out as of July 1, 2024. To avoid any interruption of visit record keeping, you should now download the latest version of the app. 

Please contact Provider Services with questions:  

• EVV email box  

• 1-866-690-5585, option 3.

• Read more about Health Inspection Program Administration Rule

The Department’s Health Inspection Program (HIP) is adopting changes to its rule, to update requirements consistent with PL 2021, ch. 125, as well as to clarify language that improves protection of patrons of eating establishments, lodging places, campgrounds, recreational and sporting camps, youth camps, and public pools/spas in Maine.

• Read more about RESCHEDULED: Section 45, Hospital Service Providers:  Public Forum Draft Reimbursement Methodologies 

The Department has identified a new date and time for the Section 45 public review and comment forum.  

Public Review and Comment 

• Read more about MaineCare Cost of Living Adjustments (COLAs) Effective July 1, 2024

MaineCare is increasing reimbursement rates for certain services in the policy sections listed below, through a COLA as directed by MRS Title 22, §3173-J (referred to as ‘Rate Reform Statute’). The COLA will be effective July 1, 2024, and is equal to an increase of 2.54% above the currently established rate(s). This COLA increase is proportional to the percentage increase in the Maine minimum wage as determined by the Maine Department of Labor.

• Read more about Attention Section 45, Hospital Distinct Psychiatric and Distinct Substance Use Disorder (SUD) Units: July 2024 Cost of Living Adjustment (COLA) Updates

MaineCare is increasing the per-diem base rates for Section 45, distinct psychiatric and distinct SUD units, as directed by MRS Title 22, §3173-J (referred to as ‘Rate Reform Statute’). The increase will be effective July 1, 2024. This increase is calculated by using inflation provided by the economic trend factor from the most recent addition of the “Healthcare Cost Review” from IHS Markit. 

• Read more about Recoupment of Claim Payments for Non-Covered Services Processed Under the COVID-19 Uninsured Benefit After the End of the Federal Public Health Emergency (PHE)

As explained in the January 17, 2024, e-message, MaineCare’s COVID-19 Uninsured Benefit was available for uninsured individuals through the end of the federal PHE, which ended May 11, 2023. MaineCare will not pay for services for this population for dates of service after May 11, 2023.  

• Read more about Section 31, Federally Qualified Health Centers (FQHCs) Annual Cost of Living Adjustments (COLAs) Effective July 1, 2024

MaineCare is increasing reimbursement rates for Section 31, FQHCs through a COLA directed by MRS Title 22, §3173-J (referred to as ‘Rate Reform Statute’). The COLA will be effective July 1, 2024. New rates were calculated using the FQHC Market Basket percentage as published by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services as directed by MRS Title 22, §3174-V.

• Read more about Section 23, Developmental and Behavioral Clinic Services: Child Abuse Evaluations, Comment Summary and Final Draft Rate

On May 13, 2024, the Office of MaineCare Services initiated a rate determination process* for Section 23, Child Abuse Evaluations. We held a virtual public forum on May 17, 2024, to present the draft rate model to interested parties and allowed for public comment.  Interested parties were able to submit written comments through May 21, 2024.