DHHS → node
In order to promote access to Sublocade, Extended Release Buprenorphine (XRB), MaineCare may engage in rulemaking. In the meantime, providers may bill the medical benefit for XRB without Prior Authorization (PA) if their documentation meets the criteria outlined below. The criteria will be available on the Preferred Drug List after the July 2023 update. Failure to meet these criteria could result in sanctions.
MaineCare added Hepatitis A vaccination codes to the Roster Billing code list. Roster Billing Specifications can be found here.
On June 28, 2023, at 8:00PM, MEPOPS will be unavailable for eight (8) hours, due to system maintenance. Pharmacy claims will not be adjudicated during this time. We apologize for any inconvenience this may cause.
If you have any questions regarding this blackout period, please call the Change Healthcare Provider Help Desk at 1-888-420-9711.
MaineCare covers brand name Suboxone film and generic buprenorphine/naloxone tablets as “Preferred” covered products for treatment of opioid use disorder (OUD) as they are the most cost-effective forms of treatment on the MaineCare Preferred Drug List (PDL). Providers may choose to prescribe buprenorphine/naloxone combination product or buprenorphine monotherapy for patients who are pregnant.
In July 2022, the Office of MaineCare Services received federal approval to expand services for MaineCare-enrolled parents with SUD, who are involved with Child Protective Services (CPS), or at risk of being involved with CPS. The expanded services are available through three pilot programs under a Medicaid SUD 1115 Waiver first approved by CMS on December 22, 2020, which allows federal Medicaid reimbursement for SUD treatment in facilities with more than 16 beds.
Providers whose facility license is under a Title 5 review may use their Title 5 notice to extend their enrollment with MaineCare in MIHMS by six months, and for every six months thereafter, until the Title 5 review is resolved. Providers must complete this update by submitting a maintenance case via the Health PAS Online Portal. Providers can utilize the Provider Maintenance User Guide for a step-by-step guide for submitting a Title 5 Maintenance Case.
Jun 6, 2023
Today, the Maine Department of Health and Human Services (DHHS) announced it is extending the current Child Care Provider Transition Grants to help child care providers continue to rebound from the COVID-19 pandemic and improve access to quality child care in Maine.
The grants, originally set to end in May 2023, will continue to September 2023. Nearly 1,300 Maine child care providers will continue to receive $25 per licensed capacity or “slot” through the grant program.
Acentra Health, formerly known as Kepro, in collaboration with the Office of Behavioral Health will be hosting two provider training sessions to review the Treatment Episode Data Sets (TEDS) submission requirements in the Atrezzo portal. The TEDS data submission is a requirement of all licensed SUD providers in Maine for the State to receive federal funding support for SUD treatment services and programs.
This rule change proposes to increase the income limit from 185% of the Federal Poverty Level (FPL) to 225% of the FPL consistent with 22 M.R.S. Section 3790-A(2)(E) (2017), amended by PL 2023 Ch.
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed 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.