• Read more about Interpreter Services – Rate Determination Kickoff Meeting

On March 31, 2025, the Department will host a virtual “kick off” meeting with interested parties via Zoom. At this meeting, we will provide an overview of the project goals, the scope of this work, and a timeline that includes additional opportunities for interested parties to participate and provide feedback.

Meeting Date/Time

Interpreter Services, Rate Determination Kickoff Meeting

Date/Time: Monday, March 31, 2025, 11:00 AM – 12:30 PM

Registration Link

• Read more about Attention Hospital Providers: Microdyn Update for Ambulatory Payment Classification (APC) & DRG Errors

Effective February 15, 2025, the Center for Medicare and Medicaid Services’ (CMS) quarterly updates are complete in MIHMS. 

The following CMS documents provide the details of the APC (CRs 129832 & 129843) updates:

• Read more about Prior Authorizations (PAs) for Certain Dental Services

When submitting a PA request to exceed quantity limits for services that do not require a PA, please remember to indicate that the request is being made to exceed limits dictated in policy on the PA form. PA requests that do not include this information may be denied for No PA Necessary (NPN) and then you must resubmit the request.

For questions regarding PAs for any dental services, please contact, Shannon Beggs, Provider Relations Specialist.  

• Read more about MaineCare Hearing Aid Procurement Contract Coding Error

The contract with Sivantose, Inc – NJ Signa contained an error in the Hearing Aid Procurement contract. The Contract Pricing Link (PDF) document contains several instances of the Healthcare Common Procedure Coding System (HCPCS) code V5180, which was discontinued.

• Read more about Primary Care Plus (PCPlus) Quality Webinar: Lead Screening in Children

PCPlus providers are invited to a quality webinar series about best practices regarding quality measures in the PCPlus program. This series is intended to educate practices on how to optimize their performance, and payment, while aligning with industry best practices for population and patient health. We will host approximately one webinar a month during 2025.

• Read more about Youth Camp Rule, 10-144 CMR Ch. 208

The Maine CDC Health Inspection Program is proposing to update and clarify safety and wellness standards for its Rules Relating to Boys, Girls, Boys and Girls, Day Camps and Primitive and Trip Camping (10-144 CMR Ch. 208), which was last updated in 2007. The Department is proposing to change the rule title, add and clarify definitions, incorporate application, licensing and enforcement provisions and requirements from its Administration and Enforcement of Establishments Regulated by the Health Inspection Program Rule (Ch.

• Read more about MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the 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.

• Read more about REVISED Medicare Standardization Rates Effective January 1, 2025: Sections 15, 75, & 95 - CRs 129368, 129491, 129354

MaineCare made updates to Section 15, 75, and 95, Medicare covered codes and rates to align with recent revisions made by the Centers for Medicare and Medicaid Services (CMS). These new rates now reflect 72.4% of the most recent 2025 Medicare rates.

Rates were implemented on the dates listed in the table below, for the following sections:

• Read more about Section 97, Private Non-Medical Institutions, (PNMI) Appendix D, Temporary High Intensity Services Rate Determination: Presented Materials and Comment Deadline

On February 14, 2025, MaineCare held an online public meeting to present draft rates and models along with the rationale for PNMI, Appendix D, Temporary High Intensity Services. Interested parties had the opportunity to provide public comments.

• Read more about Correction to MaineCare Dental Metrics Reporting

MaineCare identified and corrected an error in the MaineCare Dental Metrics reporting. 

Due to a data filtering error, previous publications of the MaineCare Dental Metrics Report excluded rendering providers in instances where the billing provider is also the rendering provider on the claim, resulting in understated counts of dental rendering providers.