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Following two years of discussions with interested parties, we implemented a new approach to MaineCare NF payments for 2025. Phase I of NF rate reform establishes a new pricing model for general care in NFs.
The Beneficiary Advisory Council (BAC) is a dedicated group of individuals with lived experience who help shape access to quality healthcare, policies, and MaineCare services across the state.
We believe that the best solutions come from those directly impacted by Medicaid - whether as recipients, family members, or caregivers.
MaineCare is excited to announce the rebrand of the EPSDT program.
The program is now called VitalCare for Kids!
VitalCare for Kids will maintain the national standards of care federally required under EPSDT to ensure children get the health care they need when they need it – the right care, to the right child, at the right time, in the right setting.
The Department adopted the amended 10-144 CMR Chapter 708, Rules Relating to the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Maine, for consistency with concurrent adoption of 10-144 CMR Chapter 707, effectively implementing expanded coverage under the Maine Center for Disease Control and Prevention - Breast and Cervical Health Program (MBCHP). The adopted amendments to Chapter 708 are consistent with the proposed non-substantive changes that include a revised rule format and language for conformity with agency standards.
The Department adopted amendments to 10-144 CMR Ch. 707, Rules Relating to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Maine to expand coverage and eligibility for the Maine CDC Breast and Cervical Health Program (MBCHP) to include qualifying participants who are 21 to 34 years old and the addition of human papillomavirus (HPV) testing as another service in rule that MBCHP will cover when determined medically necessary and provided by a participating MBCHP Provider.
Effective January 1, 2025, MaineCare updated the rates for Section 55, Laboratory Services. The new rates were implemented for billing on February 26, 2025. You may view the updated fee schedule on the Rate Setting page of the Health PAS Online Portal.
The new criteria sheet NFs Bariatric Care is available by logging into your Trading Partner Account in the secure section of the Health PAS Online Portal. Once logged in, please follow this pathway: MaineCare Information > Prior Authorizations > Manual, Forms, and Criteria Sheets > Policy Section 67, NF Services.
If you have questions, please email Provider Services or call 1-866-690-5585. TTY users dial 711.
Effective May 1, 2025, Lifescan products, including One Touch test strips and meters, will no longer be included on the PDSL.
To ensure a smooth transition, we recommend providers begin changing to a preferred blood glucose meter and test strip combination ahead of this date.
The Transforming Maternal Health (TMaH) model is a grant-funded initiative through the Centers for Medicare and Medicaid Services aimed at improving maternal and perinatal health outcomes. Maine was selected for participation in December 2024, and the state’s TMaH initiative officially launched in January 2025.
As previously announced in September of 2024, MaineCare removed all documented add-on amounts associated with the service provider tax for MaineCare reimbursements, effective January 1, 2025.
The codes and modifiers listed in the table below for sections 18 and 20 are now updated to reflect this rate change and no provider action is needed.