• Read more about MaineCare Rate Reform Technical Advisory Panel (TAP) Meeting and Public Stakeholder Forum on Draft Rate Determination Schedule

P.L. 2022, Ch.639 codifies into statute the principles and processes by which MaineCare sets its rates. Pursuant to Ch. 639, the Department must: 

• Read more about Re-Opening of PCPlus Application

MaineCare Services is pleased to announce that beginning October 7, 2022, we will again accept applications for participation in MaineCare’s Primary Care Plus (PCPlus) program. PCPlus is a MaineCare primary care model that gives Primary Care Providers (PCPs) greater flexibility and incentives to meet MaineCare members’ healthcare needs. MaineCare is transitioning away from a volume-based (fee-for-service) payment system toward population-based payments tied to cost and quality-related outcomes.

• Read more about Atrezzo Upgrade

On Monday, November 7, 2022, Kepro will upgrade their web-based platform to Atrezzo Next Generation. The Atrezzo Next Generation (ANG) platform is an improved interface with enhanced security features such as Multi-Factor Authentication (MFA). ANG brings the Maine Administrative Services Organization (ASO) an even more flexible, intuitive, and highly automated system that streamlines the utilization review and reporting processes for clients and providers.

• Read more about Clarification of Biosimilar Ocular Use 

MaineCare implemented a Biosimilar Preferred Drug List (PDL) this past May that establishes preferred and non-preferred Physician-Administered Drugs (PADs). Preferred drugs are available without a Prior Authorization (PA), and non-preferred drugs require a PA.  

• Read more about Link to HCBS Compliance Form for Waiver Services Providers, CR 99064

The state is requiring that providers who fall under Sections 18, 20, 21, and 29 fill out a

• Read more about Attention Section 28 Providers: Update on Type 92 Early Childhood Provider Certification Letters, CR 71822  

MaineCare now requires accurate certification information for Type 92 providers prior to approval for that provider type. The certification consists of an approval letter from the Maine Department of Education that indicates the approval period.

• Read more about NF and RCF Letters Are Available

The Department has posted Rate Letters for State Fiscal Year 2023 for Nursing Facilities (NFs) and Residential Care Facilities (RCFs, PNMI Appendix C) to the Health PAS Online Portal, and the rates have been loaded into MIHMS. Details about the timing of these rates were announced in a prior bulletin on August 31, 2022.  

• Read more about Dental Changes Effective September 28, 2022

On September 23, 2022, the Department adopted Section 25, Dental Services and Reimbursement Methodology, which is effective beginning today, September 28, 2022. This rule makes the following changes to covered service limits, prior authorization (PA) requirements, and rate changes that differ from the emergency Section 25 rule that has been in effect since July 1, 2022. 

Covered Service Changes 

• Read more about MaineCare Benefits Manual, Chapter II, Section 25, Dental Services (repeal); Chapter III, Section 25, Allowances for Dental Services (repeal); Chapter II, Section 25, Dental Services and Reimbursement Methodology (this rule replaces the two repealed rules

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

• Read more about Attention Providers of Sections 13, 17, 28, 65, 92 Draft Rate Model(s) Public Comment Period

Earlier this year MaineCare conducted a survey of Behavioral Health and Other Services providers. We used the provider responses to create and draft rate models for the services as part of the rate determination process. We outlined this process in a bulletin on April 22, 2022.