• Read more about MaineCare Updates: Preparing for the End of the Public Health Emergency (PHE)

At the beginning of the COVID-19 pandemic, the federal government declared a PHE and relaxed certain requirements to ensure Medicaid members could continue to access healthcare services. The federal government has declared that the PHE will end on May 11, 2023.   

Starting May 12, 2023, some billing flexibilities and how MaineCare members access health care services will revert to how they were administered prior to the declaration of the PHE.   

• Read more about Delivery System Reform Unit (DSRU) Annual Forums

Registration is now open for MaineCare's annual forums for Accountable Communities (AC), Behavioral Health Homes (BHH), Community Care Teams (CCT) including HOME providers, MaineMOM, Opioid Health Homes (OHH), and Primary Care Plus (PCPlus) providers.   

MaineCare is offering three different opportunities for trainings this year. Two different forum learning sessions are available virtually. The third is available in-person and will feature the same information at each session. Please see the table below.    

• Read more about Electronic Visit Verification (EVV) Trainings and Forums

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. 

• Read more about Delivery System Reform Unit (DSRU) Annual Forums

Registration is now open for MaineCare's annual forums for Accountable Communities (AC), Behavioral Health Homes (BHH), Community Care Teams (CCT) including HOME providers, MaineMOM, Opioid Health Homes (OHH), and Primary Care Plus (PCPlus) providers.   

MaineCare is offering three different opportunities for trainings this year. Two different forum learning sessions are available virtually. The third is available in-person and will feature the same information at each session. Please see the table below.   

• Read more about Section 25 Dental Providers: Health PAS Online Portal Direct Data Entry (DDE) Claims Submission Issue, TR 116587

On April 11, 2023, we notified providers there was an issue with the Health PAS Online Portal that affects the ability to submit multiple service lines on claims. We have corrected the issue.

You can now adjust paid claims to add missing claim lines for full payment or submit new claims with the missing unpaid claim lines.

• Read more about Attention Dental Providers: How to Add Coordination of Benefits (COB) Information for Medicare C Primary Dental Claims, CR 117131

Currently, the Health PAS Online Portal does not accept Medicare Part C dental COB data in the COB field of the Direct Data Entry (DDE) Dental claim. Entering Medicare Part C primary dental payment information as a Third Party Liability (TPL) primary payment on the portal may result in a claim processing incorrectly. 

Until this issue is corrected, please submit dental claims with a Medicare Part C payment either on a paper claim or via an Electronic Data Interchange (EDI) submission.

• Read more about Maine Pediatric & Behavioral Health Partnership Webinar Fostering Resilience

Please join us on May 10, 2023, 7:30-8:30 AM, via Zoom Webinar. You can register Here. 

 
Learning Objectives: 
1. Learners will develop an understanding of resilience and the core capabilities that support it. 
2. Learners will develop strategies that support regulation in clients and patients.  
3. Learners will develop strategies that support regulation and resilience in providers. 

• Read more about Billing Guidance and Implementation Timing for the Updated Payment Methodology for Section 31, Federally Qualified Health Centers (FQHCs), Including Changes When Providing Services Now Outside the Encounter Rate

The Office of MaineCare Services (OMS) previously announced that we will submit a State Plan Amendment to add an Alternative Payment Methodology (APM) option for FQHCs, effective March 1, 2023. This APM is based on costs and visits from fiscal years 2018 and 2019 for all State Plan covered services, with the exceptions identified in the lists below, consistent with federal requirements. 

• Read more about MaineCare Benefits Manual, Section 90, Physicians Services

AGENCY: Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 90, Physicians Services

• Read more about MaineCare Benefits Manual, Section 65, Behavioral Health Services

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 65, Behavioral Health Services

NATURE OF PROPOSED CHANGES: The Department plans to update reimbursement for Healthcare Common Procedure Coding System (HCPCS) code H2030 (clubhouse services) from $7.31 to $8.67 effective May 1, 2023.