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As a follow-up to our June 21, 2022, e-message regarding Behavioral Health and Targeted Case Management supplemental payments for providers of:
This bulletin provides notice that the Department has initiated a Rate Determination Process* for Hospital Services, with the exception of Distinct Psychiatric and Substance Use Disorder Unit services for which the Department recently completed a rate determination, under Section 45 of the MaineCare Benefits Manual.
MaineCare, and its vendor will host the 5th Rate Workgroups meeting on June 26, 2023. Presented materials will then be posted to the Rate System Reform webpage shortly after. Please watch for future notices.
The FY 2024 Section 50 ICF rate letters are now available on the secure Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: Exchange > Reports > Rate Setting Letters.
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.