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Maine exercises an option for Broad Based Categorical Eligibility under 7 C.F.R. § 273.2(j)(2) which includes a 200% Federal Poverty Level (FPL) test.
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules
The EVV requirements for Home Health providers delivering services under Section 40 were implemented on January 1, 2023.
We continue to offer weekly 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
In a letter released October 27, 2023, the U.S. Department of Health and Human Services (HHS) announced the plan to transition two COVID-19 oral therapeutics from government supplied to the commercial market. The transition process started on November 1, 2023, for Paxlovid manufactured by Pfizer and Lagevrio, manufactured by Merck.
In order to ensure MaineCare members get the health care services they need, and have the information necessary to make informed decisions, MaineCare has created a new Gender Affirming Care Coverage Guide. This guide helps answer member’s questions about what MaineCare covers and offers helpful links to find providers who offer this care.
As previously shared in our October 13, 2023, bulletin, the Department has initiated a rate determination process for Dental Services. We are rebasing the existing benchmarks so that they reflect the most recent data for the payer source.
This bulletin provides notice that the Department has initiated a Rate Determination Process* for PCPlus services and is in the final stages of procuring a vendor. This is a rate determination to establish a more advanced alternative payment model for primary care services and supports, including the incorporation of Community Health Worker (CHW) team members and social risk adjustment. This work will be referred to as PCPlus “Phase Two.”
Billing providers must include the National Provider Identifier (NPI) of an enrolled MaineCare practitioner who is ordering, prescribing, or referring on their claims to receive reimbursement for the categories of services listed below. These practitioners are known as NOPRs and must enroll in MaineCare independently or as part of an organization.
This requirement is for all prescription claims (including Point of Sale claims) as well as claims for the following: