DHHS → node
In order to promote access to Sublocade, XRB, MaineCare may engage in rulemaking. In the meantime, providers may bill the medical benefit for XRB without prior authorization 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 Extended-Release Buprenorphine Clinical Criteria
Jun 6, 2023
New data indicate that a Department of Health and Human Services (DHHS) initiative to fund recruitment and retention bonuses for direct support workers (DSWs) helped stabilize and grow Maine’s Home and Community Based Services (HCBS) workforce.
HCBS DSWs assist Maine people of all ages with physical disabilities, intellectual and developmental disabilities, and mental or behavioral health conditions. Their work is central to keeping people in their homes and communities while providing accessible, high-quality services to help them stay healthy and fulfil their personal goals.
Psychiatric Hospital providers seeking to bill for Mental Health Intensive Outpatient (MH-IOP) Services under MaineCare Benefits Manual (MBM) Ch. II, Section 46.05-3 will be asked to submit PA requests through Atrezzo. Acentra Health (formerly Kepro) will review these requests in accordance with the substantive standards for MH-IOP services adopted in the November 9, 2022, revision of MBM Ch. II, Section 65 (Behavioral Health Services).
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
The federal deadline to implement the EVV requirements for Home Health providers delivering services under Section 40 and Hospice providers delivering services under Section 43 happened January 1, 2023.
We continue to offer weekly provider and aggregator trainings and forums. All trainings and forums are online via Microsoft Teams.
NOTE: The Absorb training system has been updated to allow providers to register for trainings and/or forums more than once.
HRSN Webinar Series
WEBINAR SERIES
Thank you to the Maine Health Access Foundation for their support on this webinar series!
Effective June 3, 2023, the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates in MIHMS were completed.
The following CMS documents provides the details of the APC updates:
April 2023 Integrated Outpatient Code Editor Specs:
CNSI and Kepro are now Acentra Health.
Acentra Health is focusing on expanding access to care, improving outcomes, enhancing quality, and lowering costs for the populations we serve.
This bulletin provides notice that the Department has initiated a Rate Determination Process* for Therapeutic Foster Care services under Section 97, Appendix D, PNMI of the MaineCare Benefits Manual. MaineCare’s Rate Reform Unit will conduct this rate determination.