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Jun 6, 2025
At CoverME.gov, Maine's state-based health insurance marketplace, protecting members' privacy is a top priority. That's why Maine's Office of the Health Insurance Marketplace (OHIM) does not collect or store any personally identifiable information when members browse the website or use the Plan Comparison Tool.
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: The MaineCare Accountable Communities Program
On March 5, 2025, the Department shared that it would temporarily hold certain MaineCare provider payments beginning with the payment cycle that ran on March 12, 2025. Payment withholding has continued since then utilizing the same approach. In anticipation of receiving supplemental funding for Fiscal Year 2025, provided in P.L 2025 Ch.
The purpose of this notice is to clarify the MaineCare Benefits Manual (MBM), Chapter I, Section 1, Rounding Rule. MBM Chapter I, Section 1.03-8 (J) advises how to apply the Rounding Rule when partial units are delivered.
The Rounding Rule does not apply when a service code requires a minimum amount of time that must be met or exceeded. For example, Evaluation and Management (E&M) code sets 99202-99205 and 99212-99215 are defined by a minimum time duration met or exceeded on the Date of Service (DOS) as shown in the table below.
The Section 97, Appendix F, FY 2026 rate letters will be accessible on the secure Health PAS Online Portal by July 1, 2025. To view your rate letter(s), log into your Trading Partner Account and follow this pathway: File Exchange > Reports > Rate Setting Letters.
If you have questions about accessing your letter(s), please contact Provider Services at 1-866-690-5585.
For questions about the content of your letter(s), please contact Rate Setting directly by using the contact listed on the letter.
Earlier this month, MaineCare issued supplemental payments to nine hospitals rewarding the high levels of primary care utilization for MaineCare members in their Hospital Service Areas (HSAs). The table below shows how the top eight (8) HSAs, which include nine (9) hospitals, surpassed the statewide average of 57% of MaineCare members within the HSA with a primary care visit in 2024.
Jun 6, 2025
The recently passed FFY 2025 budget reconciliation bill (the "One Big Beautiful Bill Act") contains significant Medicaid (MaineCare) policy changes, including a mandatory work requirement provision for Medicaid expansion members and the removal of good faith waivers for Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) audits with error results above a certain low threshold. This document provides an overview of the potential impacts to Maine's Medicaid program.
This emergency routine technical rulemaking is necessary to comply with Federal Rule updates according to 42 U.S.C. 9858 et seq., 45 C.F.R. Pt. 98, which makes multiple changes to the payment structure of the Child Care Affordability Program, including:
This routine/technical rulemaking is necessary to comply with Federal Rule updates according to 42 U.S.C. 9858 et seq., 45 C.F.R. Pt. 98. The Department adopted the changes outlined below on an emergency basis on 5/19/25, and this proposed rulemaking will adopt these changes before the emergency rule expires on 8/17/25 at 11:59pm EST (U.S. and Canada). This rulemaking proposes to promulgate on a non-emergency basis changes to the payment structure of the Child Care Affordability Program, including: