MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual Chapter II, Section 89
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules
MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual Chapter II, Section 89
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 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
MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 89
COVID-19 Therapeutics Transition to Commercial Market, and UPDATE on COVID-19 Vaccine Coverage
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.
MaineCare Gender Affirming Care Coverage Guide Now Available
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.
Attention Providers of Section 25, Dental Services: Kickoff Meeting Presented Materials
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.
Rate Determination Initiation Notice for Section 3, Primary Care Plus (PCPlus) Phase Two
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.”
Non-Billing, Ordering, Prescribing, and Referring (NOPR) Edits Changing from Warn to Deny – CR 121469
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:
Application Fee for 2024 Reminder, CR 121257
Effective January 1, 2024, in accordance with the Centers for Medicare & Medicaid Services (CMS) application fee requirements, MaineCare’s provider enrollment application fee will increase to $709 per enrollment application. This increase will apply to new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.