• Read more about MaineCare Provider Enrollment Progress Update

Gainwell continues to reduce the time it takes to complete their steps within the MaineCare enrollment process. Gainwell completed 559 enrollment cases in March and the average turnaround time for case completion was approximately 20 days. Case inventory was 578 at the end of March and the average system age of a case in inventory dropped to approximately 16.4 days old.

Additionally, to improve MaineCare enrollment, the Office of MaineCare Services (OMS) and Gainwell:

• Read more about MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT)

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

• Read more about Attention Primary Care Plus (PCPlus) Practices - Open Application Period Required for all PCPlus Practices

As a reminder, the PCPlus application period is currently open. The open application period runs through Friday, May 3, 2024. 

• Read more about Pemgarda (pemivibart) Receives Emergency Use Authorization (EUA)

On March 22, 2024, the Food and Drug Administration (FDA) issued EUA for Pemgarda for the prevention of COVID-19 for individuals aged 12 and up with moderate to severe immune compromise due to a medical condition or taking immunosuppressive medications or treatments. These individuals are unlikely to mount an adequate immune response to COVID-19 vaccines. Pemgarda is not a substitute for COVID-19 vaccinations.

• Read more about Attention Section 18, 21, and 29 Providers: Evergreen Electronic Data Interchange (EDI) 837 Prior Authorization (PA) Issue Resolved, CR 123785

Evergreen PAs, with the prefix “LTS” issued prior to March 16, 2024, were created with 17-character IDs. EDI claims submitted with those PAs were being denied with the “UM not found” edit because the EDI 837 file was developed with a maximum of 15 characters for PA IDs. 

The Department implemented a fix for this issue, and the system was updated to reflect the changes on April 16, 2024.

• Read more about CORRECTION to Comment Deadline: Section 25, Dental Benchmarking Results and Draft Rates, Presented Materials and Comment

Please note: The correct deadline for written comments is April 26, 2024.

Public Review & Comment

• Read more about Comment Deadline Extended: Section 67, Nursing Facilities (NF) Draft Rate Methodology

In response to requests from NF providers, MaineCare is extending the deadline for written comments on the draft rate methodologies, from April 15, 2024, to April 23, 2024. Please see our March 12, 2024, notice that followed the public forum, for more information on where and how to submit comments through our vendor.

• Read more about MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT)

Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

CHAPTER NUMBER AND TITLE:  10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT)

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

• Read more about CORRECTION to Comment Deadline: Section 25, Dental Benchmarking Results and Draft Rates, Presented Materials and Comment

Please note: The correct deadline for written comments is April 26, 2024.  

Public Review & Comment 

• Read more about Attention Residential Care (PNMI-C) Facilities: CoreQ Resident and Family Satisfaction Survey Pilot

Please express interest by April 19, 2024

Introduction:

Person-reported outcomes (PROs) are an important way for organizations, providers, and facilities to assess their success in meeting the person-centered needs of patients and residents under their care.  While some nursing home facilities are collecting CoreQ data as one of their quality measures, most residential care facilities are not.