REVISED - Medicare Standardization Rates for Calendar Year 2024 (CY24)

The Centers for Medicare & Medicaid Services (CMS) has revised its rates effective March 9, 2024. To align with these changes, the Department is in the process of updating reimbursement rates for Medicare covered codes and services for the sections noted below. The new rates will reflect 72.4% of the most recent, 2024 Medicare rates.   

Evergreen Users Billing 837 Claims

With the new Evergreen system rollout, previous authorizations with a prefix of “EIS” have been replaced by new authorizations with a prefix of “LTS.”    

Our current Electronic Data Interchange (EDI) 837 file was developed with a max of 15 characters for authorization IDs. Some LTS authorization IDs were generated with a max of 17 characters. When submitting 837 claims, providers are reporting that the last two characters of the 17-character authorization ID are getting cut off, resulting in denied claims with the “UM not found” edit.    

Palliative Care Interdisciplinary Team Services (Section TBD) – Rate Study Kickoff Presented Materials

On March 27, 2024, MaineCare held a virtual public meeting with interested stakeholders to present the Palliative Care Team (PCT) Services Draft Model and provide an overview of a Staffing Survey for current palliative care providers. Stakeholders were able to ask questions and participate in an open discussion.  

10-144 CMR Ch 111, Temporary Nurse Agency Registration Rule

This new rule operationalizes the changes made to 22 MRS § 2313 under PL 2023 Ch 434. The rule reflects the following requirements of statute:

  • Increases the registration fee;
  • Places requirements for annual reporting on registered Temporary Nurse Agencies (TNAs);
  • Authorizes the Department to issue financial penalties to TNAs in certain circumstances;
  • Places record-keeping and access to records requirements on TNAs; and
  • Establishes employee quality assurance measures for TNAs.

Attention Primary Care Plus (PCPlus) Practices: Reminder - PCPlus Open Office Hour 

The Delivery System Reform Unit (DSRU) will be holding a PCPlus Open Office Hour on Friday April 5th , 2024 from 12 – 1pm. The purpose of the Open Office Hour is to provide an accessible online venue for PCPlus providers to come and ask MaineCare questions you might have regarding the PCPlus program. If you have any questions about the PCPlus application process, this also a great opportunity to ask those questions. 

Attention Primary Care Plus (PCPlus) Practices - PCPlus Application and Recertification Opening – Required for all PCPlus Practices

MaineCare Services is pleased to announce that the PCPlus application period is now open. The open application period runs through Friday, May 3, 2024. 

PCPlus is a MaineCare primary care model that gives Primary Care Provider (PCPs) greater flexibility and incentives to meet MaineCare members’ healthcare needs by transitioning away from a volume-based (fee-for-service) payment system toward population-based payments tied to cost and quality-related outcomes. Participation in PCPlus is voluntary for PCPs, and PCPs must apply to participate.    

Subscribe to