• Read more about Certified Community Behavioral Health Clinic (CCBHC) Certification Documentation Due September 6, 2024

On December 13, 2023, MaineCare noticed the opportunity for an initial cohort of prospective CCBHCs to submit provisional certification materials. The Department is now accepting final certification documentation from provisionally certified providers. The Department will review submissions for final approval and full certification status and participation in Maine’s CCBHC Demonstration program.

• Read more about ​Attention Section 65, Behavioral Health Services Providers: Temporary Claims Payment Delay

Attention Section 65 Providers, Section 65 claims are temporarily pending due to an error in Gainwell’s implementation of the January 1, 2024, COLA. Gainwell corrected the error. Affected claims will process in this week’s reimbursement payment cycle which will issue reimbursements on August 23, 2024.  

• Read more about MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

Notice of Agency Rule-making Proposal

AGENCY:  Department of Health and Human Services (DHHS), MaineCare Services, Division of Policy

CHAPTER NUMBER AND TITLE:

10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

PROPOSED RULE NUMBER:

CONCISE SUMMARY:

• Read more about MaineCare Rule #309P - DEL Updates

The proposed rule change would update Section 2, APPLICATION PROCESS, consistent with a legislative change to 22 M.R.S. § 3174-LLL made by P.L. 2023, ch. 412. Effective retroactive to July 1, 2024, individuals who are enrolled in Medicaid and/or Medicare Buy-In (MSP), who are eligible for Medicare Part D, and meet the income criteria in Section 2.2, are deemed to be eligible for and enrolled in DEL. These individuals do not need to file a separate application.

In addition, the proposed rule would make the following changes:

• Read more about Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program for Children and Youth – New Provider Resources Available

MaineCare’s EPSDT program allows MaineCare members under the age of 21 to receive medically necessary services that are not typically covered due to limits on the type, frequency, or duration of the service. These services can include preventive, dental, developmental, behavioral health, and specialty services.

Comprehensive EPSDT program resources are now available for providers:

• Read more about Virtual Forum for Dental Service Providers

MaineCare is hosting a second dental forum on August 28, 2024, from 12:00 PM – 1:00 PM where we will share information and look forward to your feedback, ideas, and questions about MaineCare dental services.

The beginning of the forum will include a presentation from MaineCare about specific topics. After the presentation, we will open the forum for questions and discussion.

• Read more about Update Your MaineCare Enrollment with Accurate Information

All MaineCare Providers are required to update any change in their enrollment within 10 days of the change per Chapter I, Section 1.03-1(B) of the MaineCare Benefits Manual (MBM). These updates can be but are not limited to:

• Read more about Critical Access Hospitals (CAH) Swing Bed and Nursing Facility (NF) Days Awaiting Placement (DAP) Rate Updates, CR 125823

Effective July 1, 2024, the Critical Access Hospital (CAH) swing bed rate and Nursing Facility (NF) days awaiting placement (DAP) rates have been recalculated for State Fiscal Year 2025. You can view both related memos on the rate setting page of the Health PAS online portal. 

• Read more about MaineCare Notice of Agency Emergency Rule-making Adoption, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

Notice of Agency Emergency Rule-making Adoption

AGENCY: Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE:

10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

EMERGENCY RULE

• Read more about Notice of Agency Emergency Rule-making Adoption, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

Notice of Agency Rule-making Adoption

AGENCY: Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE:

10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

EMERGENCY RULE