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Emergency Services, also known as Emergency MaineCare, is a limited benefit that covers emergency medical services to stabilize the emergency condition only. For proper reimbursement, providers must use Admission Type “1” on the UB04 claim form or the Emergency Indicator “Y” on the CMS 1500 claim form.
Beginning September 1, 2025, MaineCare will only pay for prescriptions that are from providers who are enrolled with MaineCare.
On July 2, 2025, we sent a notice stating that the implementation of the 1.95% COLA for several sections of policy was delayed.
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) Rate Letters
On June 5, 2025, MaineCare announced we planned to increase reimbursement rates through a Cost-of-Living Adjustment (COLA) for certain services, effective July 1, 2025. For select providers, this increased the part AAAA add-on and is in addition to the 1% direct care adjustment that is pending a 90 day wait. See the July 3, 2025, announcement for those details.
10-144 C.M.R. Ch. 330; Higher Opportunity for Pathways to Employment (HOPE) Rules
Section 4
HOPE Rule 104A - Dental Services Update
10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules
Section 111-7
SNAP Rule #238A - ABAWD Update
The adopted rule effectuates routine technical changes to 10-144 C.M.R. Chapter 301; Supplemental Nutrition Assistance Program (SNAP) Program Rules, Section 111-7, ensuring consistency with 7 C.F.R. § 273.24(c).
Please join us on Wednesday, July 16, 2025, to learn about, and provide feedback about the next phase of MaineCare’s PCPlus reform work. This session will be an opportunity for practices to provide feedback on your experiences and insights from participating in the PCPlus model. Your input will help shape the next phase of the PCPlus Alternative Payment Model (APM).
Discussion Topics:
Jul 7, 2025
On July 4, H.R. 1 -- Budget Reconciliation was signed into law, enacting sweeping federal changes to Medicaid, nutrition assistance, and health insurance Marketplace programs. Many provisions take effect later this year or sometime between 2026--2028 and will fundamentally reshape -- and, in many cases, eliminate -- how many Maine people access health coverage and food supports.
Last week, we sent a notice stating that the implementation of the 1.95% COLA for several sections of policy was delayed.
The following policy sections received the COLA update, and the rates are now available for billing.
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HCBS for Adults with Brain Injury |
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