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Effective July 1, 2022, we have recalculated the per diem swing bed rate and nursing facility days awaiting placement rate for State Fiscal Year 2023.
Critical access hospitals can bill the new swing bed rate of $317.44 per day for dates of services July 1, 2022, through June 30, 2023.
Effective January 1, 2023, the rate for IHS providers increased to $654.00. We will adjust claims billed between January 1, 2023, and March 7, 2023, and no provider action is needed.
Please contact your Provider Relations Specialist with questions.
MaineCare wants to remind providers to update their facility licenses prior to the expiration date to avoid possible claim denials or payment delays. To update your license, you need to login to the portal, go to the MaineCare Provider Enrollment Application (PEA), and perform a maintenance case.
Due to the Centers for Medicare & Medicaid Services’ (CMS) rate update, we updated the rates for some drug codes retroactively to January 1, 2021, or July 1, 2021.
See the table below for the effective dates and rates.
The Office of MaineCare Services (OMS), in coordination with their Pharmacy Benefits Manager, Change Healthcare (CHC), reviews data from the Maine Center for Disease Control and Prevention (Maine CDC) to track the epidemic season for respiratory syncytial virus (RSV). The Maine CDC data is used for decision making because it includes a more robust and geographically diverse data set than that provided by the National Respiratory and Enteric Virus Surveillance System (NREVSS).
The Office of MaineCare Services (OMS), in coordination with their Pharmacy Benefits Manager, Change Healthcare (CHC), reviews data from the Maine Center for Disease Control and Prevention (Maine CDC) to track the epidemic season for respiratory syncytial virus (RSV). The Maine CDC data is used for decision making because it includes a more robust and geographically diverse data set than that provided by the National Respiratory and Enteric Virus Surveillance System (NREVSS).
The Office of MaineCare Services (OMS), in coordination with their Pharmacy Benefits Manager, Change Healthcare (CHC), reviews data from the Maine Center for Disease Control and Prevention (Maine CDC) to track the epidemic season for respiratory syncytial virus (RSV). The Maine CDC data is used for decision making because it includes a more robust and geographically diverse data set than that provided by the National Respiratory and Enteric Virus Surveillance System (NREVSS).
Last fall, MaineCare formally noticed that we initiated a rate determination for Section 65 Crisis Resolution and Response services. The Department’s vendor , Burns and Associates is conducting this rate determination. We kicked off this work in May of 2022.