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Cost-of-Living Adjustments (COLA)
Due to current projected budget limitations, the Department will only be applying COLAs on January 1, 2025, that are required by federal law. Other COLA adjustments will be reliant on additional appropriations by the legislature.
SPT
The Maine CDC Children and Youth with Special Health Care Needs is hosting Dr. Maggie Bordeaux of the Maine CDC Lead Program and invite you to join an insightful webinar on the effects of lead on children; children who are at risk for lead exposure, and ways to prevent lead exposure.
At the end of this presentation, participants will be able to:
Effective January 1, 2025, the Department will add preferred and non-preferred drugs to the Biosimilar PDL, listed below.
Preferred drugs:
Non-preferred drugs:
Pharmacy providers whose pharmacy license is under a Title 5 review may use your Title 5 notice to extend your enrollment with MaineCare in MIHMS by six months, and for every six months thereafter, until the Title 5 review is resolved.
The Department has initiated a Rate Determination Process for Dispensing Fees under Section 80 of the MaineCare Benefits Manual.* Maine, along with several other New England states (CT, VT, NH, RI), are participating in an initiative through New England States Consortium Systems Organization (NESCSO) to develop a reimbursement methodology for pharmacy dispensing fees. NESCSO is a non-profit organization governed by the New England State Health and Human Services agencies and the University of Massachusetts Medical School.
An updated summary of all comments resulting from both the March and October 2024 forums is available on the MaineCare Rate System Reform webpage.
The Department updated multiple physician drug codes retroactively due to a rate update from the Centers for Medicare & Medicaid Services’ (CMS). These new rates were implemented on October 23, 2024.
See the table below for the effective dates and new rates.
|
Procedure Code |
Start Date |
End Date |
Current Rate |
Revised Rate |
Effective October 1, 2024, in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, the Department retroactively updated the Physician Drug Rates. On November 20, 2024, the new rates were implemented for billing, and we then processed claims submitted on or after November 20, 2024, at the new rates.
Effective August 1, 2024, MaineCare updated the seasonal flu codes and rates for hospitals in alignment with the Centers for Medicaid Services (CMS). The new codes are now available for billing. No provider action is required as we will reprocess claims that denied in error.
See the notice from September 6, 2024, for the seasonal flu codes.