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Effective August 23, 2025, we completed the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates in MIHMS. The following CMS documents provide the details of the APC and DRG updates:
July 2025 Integrated Outpatient Code Editor Specs
July 2025 Update of Hospital Outpatient Prospective Payment System (OPPS)
On September 3, 2025, MaineCare held an online public meeting to present the recommended draft rates and rate models in addition to rationale for NF Specialty Units under Section 67 of the MaineCare Benefits Manual.
This emergency rulemaking operationalizes the statutory requirements of 34-B M.R.S. § 1203-B, Licenses for agencies that provide services to adults with certain conditions. Under this statute, any agency that provides a service, if that service is funded in whole or in part by the Department, to an adult with an intellectual disability, autism spectrum disorder, a related condition or an acquired brain injury, including a service provided under 22 M.R.S.
This routine technical rulemaking operationalizes the statutory requirements of 34-B MRS 1203-B, Licenses for agencies that provide services to adults with certain conditions. Under this rule, any agency that provides a service, if that service is funded in whole or in part by the Department, to an adult with an intellectual disability, autism spectrum disorder, a related condition or an acquired brain injury, including a service provided under 22 M.R.S.
Presenters needed for the Forum Dates & Locations:
MaineCare is once again inviting you to submit presentation proposals this year!
10-144 C.M.R. Chapter 331; Public Assistance Manual Temporary Assistance for Needy Families (TANF)
Maximum Benefit and Standard of Need Chart
TANF Rule #125P – COLA Update
The Department proposes routine technical updates to 10-144 C.M.R. Ch. 331; Public Assistance Manual Temporary Assistance for Needy Families (TANF) consistent with legislative changes made to 22 M.R.S. § 3769-C(1)(D) made by P.L. 2023, Ch. 622, § 2.
As announced in January 2025, the Office of MaineCare Services (OMS) is one of 15 state Medicaid programs selected to participate in the Transforming Maternal Health (TMaH) Model. This is a 10-year initiative supported by the Centers for Medicare & Medicaid Services (CMS) designed to improve maternal and newborn health outcomes for people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
Starting September 4, 2025, Acentra Health is implementing an automated caller authentication system to enhance security and improve customer service efficiency.
When contacting Acentra Health, both member and provider callers are prompted to answer various identifying questions to authenticate and connect the caller to the appropriate member or case record.
Examples of authentication prompts:
Prescribing providers need to enroll in MaineCare now. The Office of MaineCare Services will soon require prescriptions to be written by enrolled MaineCare prescribers, explained further in this previous e-message. We are extending the previously planned September 1, 2025, deadline to allow providers more time to complete the enrollment process.
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.