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On January 17, 2024, the Office of MaineCare Services (OMS) hosted a provider enrollment presentation and listening session. During this session OMS and Gainwell Technologies delivered presentations on the provider enrollment process and listened to comments from providers.
MaineCare is extending the Mobile Crisis Response Teams draft rate model comment deadline from January 26, 2024, to February 9, 2024.
Please consider sending comments earlier if possible, to allow the Department to continue to make progress. Comments should be submitted to Karl Matzinger of HMA-Burns at the following email: kmatzinger@healthmanagement.com
The ASAM Criteria, nationally recognized as the gold standard in treatment assessment, was first developed in 1990. A new edition, The ASAM Criteria 4th edition, was released in December 2023, with subsequent volumes including:
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules on fi
The Department is in the process of updating reimbursement rates for Medicare covered codes and services for the sections noted below, to be effective January 1, 2024. The new rates will reflect 72.4% of the most recent, 2024 Medicare rates.
Effective January 1, 2024, the Department has updated DME rates benchmarked to Medicare, to reflect 100% of current year Medicare rates. New rates have been posted to the MIHMS portal and rates will be implemented for billing on January 24, 2024.
Adjustment of Claims
Effective January 1, 2024, the Department has retroactively updated the Physician Drug Rates in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update. These new rates will be implemented for billing on January 24, 2024.
Jan 1, 2024
The Maine Department of Health and Human Services announced today that it is bringing closure to a long-standing financing issue dating back to 2018 in Maine’s Medicaid program by eliminating a CMS-contested tax on health care providers (MaineCare). This reflects Governor Mills’ commitment to responsible State budgeting and sustainable long-term financing for MaineCare, a program that provides health and long-term service and supports to over 400,000 Maine residents.
In 2021, the Maine Department of Health and Human Services (DHHS) received approval from the Centers for Medicare and Medicaid Services (CMS) to implement a Section 1115(a) Demonstration titled, Maine Substance Use Disorder Care Initiative. The goal of the Demonstration is to improve access to, and quality of treatment to MaineCare members with SUD. This included allowing MaineCare to pay for short-term stays in residential SUD treatment programs that are larger than 16 beds.
MaineCare continues to experience a high volume of provider enrollment cases, and we need your help to make progress. Gainwell regularly identifies missing information that delays their ability to complete cases and requires your immediate attention.