• Read more about State Fiscal Year (SFY) 2025 Rate Letters for Section 67, Nursing Facilities (NFs) and Section 97, Appendix C, Residential Care Facilities (RCFs)

MaineCare will increase reimbursement rates for certain services under Sections 67 NFs and 97, Appendix C, RCFs effective July 1, 2024, through a Cost-of-Living Adjustment (COLA), in alignment with MRS Title 22, 3173-J (referred to as ‘Rate Reform Statute’). The COLA is equal to an increase of 4.91% above the currently established rate(s), which is based on the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index for nursing homes and adult day care services as required under Maine P.L. 2017, ch. 460 (see 22 MRSA §1708, sub-§3, ¶F for NFs).

• Read more about Section 97, Private Non-Medical Institutions (PNMI) Appendix F: Rate Letters for Fiscal Year (FY) 2025, CR 125612

The Section 97, Appendix F, FY 2025 rate letters will be accessible on the secure Health PAS Online Portal by July 1, 2024. To view them, log into your Trading Partner Account and follow this pathway: File Exchange > Reports > Rate Setting Letters.    

If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585.     

For questions about the content of these letters, please contact Rate Setting directly by using the contact listed on each letter.  

• Read more about Section 50, Intermediate Care Facilities (ICF) Rate Letters for Fiscal Year (FY) 2025 Now Available, CR 125576

The FY 2025 Section 50 ICF rate letters are now available on the secure Health PAS Online Portal. To view them, log into your Trading Partner Account and follow this pathway: Exchange > Reports > Rate Setting Letters.    

If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585.     

For questions on the content of these letters, please contact Rate Setting directly by using the contact listed on each letter.

• Read more about Maine Breast & Cervical Health Program (MBCHP) Code & Rate Update for Fiscal Year (FY) 2025

In coordination with the National Breast & Cervical Cancer Early Detection Program and the Centers for Medicaid Services (CMS), the MBCHP has updated the approved codes and rates effective July 1, 2024.

• Read more about Attention Section 55, Laboratory Services: January 1, 2024, Rate Update, CR 124692

Effective January 1, 2024, MaineCare has updated the Section 55 rates shown below. These new rates were implemented for billing on June 6, 2024. The full fee schedule can be viewed on the Rate Setting page of the Health PAS Online Portal.

• Read more about MaineCare Issued Annual Hospital Value-Based Purchasing (VBP) Supplemental Payments and Correction to Previous Results

Earlier this month, MaineCare issued supplemental payments to nine hospitals rewarding the high levels of primary care utilization for MaineCare members in their Hospital Service Areas (HSAs). The table below shows how the top eight HSAs, which include nine hospitals, surpassed the statewide average of 57.5% MaineCare members within the HSA with a primary care visit in 2023. This sub-pool, totaling $600,000 annually, supports hospitals that partner with a MaineCare Accountable Community.

• Read more about Section 45, Hospital Services: Clarifications from June 11, 2024, Public Rate Forum

MaineCare has posted a clarifying document to supplement the information originally presented at the June 11, 2024, public rate forum for Hospital Services.  

• Read more about Maine CDC Updates Advisories on Eating Freshwater Fish Due to PFAS Contamination

Adds four new waterbodies, expands three existing advisories

AUGUSTA — The Maine Center for Disease Control and Prevention (Maine CDC) today issued updated and additional freshwater fish consumption advisories following ongoing PFAS testing of water bodies across the state.

• Read more about Deadline Extended to Apply to be a Presenter at the 2024 MaineCare Delivery System Reform Forums

MaineCare’s Delivery System Reform (DSR) Annual Forums will be held on:

• September 16, 2024, in Auburn, ME
• September 24, 2024, in Orono, ME

This year, MaineCare is turning the tables and wants to hear from YOU! Consider applying to be a presenter. The deadline to apply has been extended!

• Read more about Revalidate with MaineCare to Avoid Claim Denials

Per the Affordable Care Act (ACA), Section 6401, all providers need to revalidate with all states they are enrolled with.

Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidation began in January 2022.