Provider Enrollment National Provider Identifier (NPI) Entry Enhancement, CR 122156

NPIs, i.e. Pay To, Rendering, and Non-Billing, Ordering, Prescribing, and Referring (NOPRs) will soon be checked against the National Plan and Provider Enumeration System (NPPES) directory to see if there is a match. If there is not a match, the NPI will not be allowed entry. Providers should review the information entered to ensure accuracy. If the system still will not accept the NPI, providers should wait at least five business days and try again.

Rules for Conversion of Seasonal Dwelling Units into Year-Round Residences in the Shoreland Zone 10-144 CMR Ch 242

The Department is adopting the repeal of this rule as it has adopted amendments to Maine's Subsurface Wastewater Disposal Rules, 10-144 CMR Ch. 241 (Ch. 241). The Department clarified the requirements and updated the language within Section 8(B)(1) of Chapter 241, so that all subsurface wastewater disposal requirements are combined within one rule at Chapter 241. This amended language to Ch. 241 make the requirements in Ch. 242 no longer applicable, therefore necessitating the repeal of this rule. Effective Date: February 4, 2024.

Sections 15, 75, 109 and 95, Calendar Year 2024 (CY24) Medicare Standardization Rates Implemented, CRs 122519, 122524, 122526

In follow up to our January 19, 2024 notice, and for the sections noted below, service codes and rates are now implemented, effective January 1, 2024, to reflect 72.4% of the most recent 2024 Medicare rates.  

The Department will reprocess claims submitted for dates of service January 1, 2024, through January 30, 2024. No provider action is needed.  

Updated Fee Schedules are linked below: 

Electronic Visit Verification (EVV) Phase 2 Trainings

The EVV requirements for Home Health providers delivering services under Section 40 were implemented on January 1, 2023.

We continue to offer weekly EVV provider and aggregator trainings. All trainings are online via Microsoft Teams.

NOTE: The Absorb training system has been updated to allow providers to register for trainings more than once.

EVV Training Schedule

EVV Phase 2 Training and Aggregator Content – State and Provider Trainings

 

Targeted Case Management (TCM) Services Provided by Section 9, Indian Health Services (IHS)

Effective December 15, 2023, providers enrolled under Section 9 of the MaineCare Benefits Manual (MBM) may provide TCM Services to eligible MaineCare members. IHS providers must comply with all requirements set forth in MBM, Section 13 TCM including those regarding member eligibility, record keeping, and covered services. IHS providers are not required to hold a mental health license to provide TCM Services.

340B Program Overview

MaineCare does not allow contract or retail pharmacies to enroll in the 340B Medicaid drug program, either directly or under subcontract with a 340B entity. MaineCare is Fee For Service (FFS).

All 340B providers who submit claims to MaineCare must determine whether they will use 340B drugs for their MaineCare patients (carve-in to the program) or whether they will purchase drugs for these patients through other mechanisms (carve-out of the program).

MaineCare Notice of Agency Rule-making Proposal, Chapters II and III, Section 23, Developmental and Behavioral Health Clinic Services

Notice of Agency Rule-making Proposal

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

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, Chapters II and III, Section 23, Developmental and Behavioral Health Clinic Services

PROPOSED RULE NUMBER:

CONCISE SUMMARY:

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