Children’s Behavioral Health & Residential Treatment
Applying for Children’s Residential Care Facility Services
CBHS contracts with Acentra to manage Children’s Residential Care Facility Services (CRCF). Children’s Residential Care Facility Services for children follows the MaineCare Section 97 eligibility criteria. Acentra processes all applications and completes Prior Authorizations for Children’s Residential Care Facility Services, and they are your contact related to approval for admissions to Children’s Residential Care Facility.
10-148 C.M.R. ch. 31; Quality Rating and Improvement System: Rising Stars for ME
This rule outlines how the Maine Department of Health and Human Services (the Department) pays a differential rate for child care services that meets or that makes substantial progress toward meeting nationally recognized quality standards, as required by 22 M.R.S.A § 3737. The emergency rulemaking allows the Department to immediately start paying a higher quality differential to such early care and education programs, addressing the lack of access to high-quality early care and education programs in Maine, which presents an ongoing threat to Maine’s general welfare.
Critical Access Hospitals (CAHs) Swing Bed and Nursing Facility (NF) Days Awaiting Placement (DAP) Rate Updates, CRs 134801, 134803
Effective July 1, 2025, the CAH swing bed and NF DAP rates are recalculated for State Fiscal Year 2026. You can view both related memos on the rate setting page of the Health PAS Online Portal.
10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules; Sections 555-4 and 555-5
10-144 C.M.R. Ch. 301 – Supplemental Nutrition Assistance Program (SNAP) Rules; Sections 555-4 and 555-5
EMERGENCY RULE: SNAP Rule #242E – Income and Deductions Update
Effective Date:
September 18, 2025
Delayed July 1, 2025, Cost-of-Living Adjustment (COLA) for Section 97, Appendix C, Residential Care Facilities (RCFs)
The Department is temporarily delaying implementation of the previously announced 1.0% COLA rates for RCF direct care. The Department requires additional time to make these updates, and we anticipate implementation of new rates on October 1, 2025.
Billing Guidance for Dates of Service July 1, 2025, through September 30, 2025
Seasonal Flu Codes Updated Effective August 1, 2025, CR 134495
Effective August 1, 2025, MaineCare updated seasonal flu codes. See the table below for the new rates.
|
Start Date |
End Date |
Procedure Code |
Rate |
|
8/1/2025 |
|
90653 |
$98.16 |
|
8/1/2025 |
|
90656 |
Update to 2024 InterQual Criteria Sheets, CR 126309
Effective September 12, 2025, we updated InterQual criteria sheets on the MaineCare Health PAS Online Portal. The criteria sheets are used to establish the medical necessity of the requested services. All decisions must align with the most current criteria sheet.
30 Day Transition Period (September 22, 2025 – October 22, 2025)
Discontinuation of Coverage: Xifaxan (Rifaximin)*
Effective October 1, 2025, the manufacturer of Xifaxan (Rifaximin) will no longer participate in the Medicaid Drug Rebate Program which means it will not be covered by MaineCare. Please read below for alternative options.
Patient Assistance Program for Free Medication
Bausch Health Companies, Inc. offers a patient assistance program aimed at supplying free medication, including Xifaxan, to eligible patients who do not have coverage under their Medicaid pharmacy benefit.
Feedback Encouraged to Shape Application for Federal Funding to Support Rural Health
- Read more about Feedback Encouraged to Shape Application for Federal Funding to Support Rural Health
The State of Maine announced yesterday that it will apply for funding through the federal Rural Health Transformation Program (RHTP) and launched a public feedback process to help shape its application.