Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 13, Targeted Case Management Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 13, Targeted Case Management Services

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Family Planning Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Family Planning Services

NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement of certain family planning services, effective July 1, 2024. These changes are as follows:

Notice of MaineCare Reimbursement Methodology Change, MaineCare Benefits Manual, Section 25, Dental Services and Reimbursement

Notice of MaineCare Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 25, Dental Services and Reimbursement

Non-Emergent - Emergency Department Claims Not Pricing Correctly

MaineCare discovered that some hospital non-emergency claims failed to price correctly and were overpaid. This occurred when there was more than one emergency room service on the claim, for claims submitted for Dates of Service from January 1, 2022, and March 31, 2024. MaineCare reimburses differently in cases where non emergent use of the emergency room is determined.

No provider action is required as MaineCare will re-process these claims.

10-144 C.M.R. Chapter 331; Public Assistance Manual Temporary Assistance for Needy Families (TANF) – Maximum Benefit and Standard of Need Chart TANF Rule #121P – P.L. 2024, Ch. 622

The proposed rule change would update the Public Assistance Manual Temporary Assistance for Needy Families (TANF) consistent with legislative changes made to 22 M.R.S. § 3769-C made by P.L. 2024, Ch. 622, An Act to Reduce the Number of Children Living in Deep Poverty by Adjusting Assistance for Low-income Families.

Taxonomy Code Requested on Claim Submissions – Portal Claims

The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by  CMS to conduct program oversight, administration, and integrity.  

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