• Read more about Letrozole Use for Treatment of Infertility

The Department is aware, through pharmacy dispensing data, that short-term claims for Letrozole have been prescribed for treatment of infertility. Letrozole is a preferred agent for the treatment of breast cancer.

Pursuant to Social Security Act, Section 1927 [42 U.S.C. 1396r–8] and MaineCare Benefits Manual Chapter II, Section 90, Physician Services, the off-label use of the preferred medication Letrozole, when it is used to promote fertility, is excluded from MaineCare coverage.

• Read more about UPDATE for Providers Billing on UB-04 and 837I Claims, CR 110840  

Effective October 31, 2022, UB-04 and 837I claims submitted without an attending provider will be denied.  

• Read more about Attention Hospice Providers: Electronic Visit Verification (EVV) Soft Launch Implementation Delayed to October 4, 2022 

Federal Deadlines 

The federal deadline to implement the EVV requirement for providers delivering Home Health services under Section 40 and Hospice Services under Section 43 is January 1, 2023.  

• Read more about November 1, 2022 Suggested Integration Deadline for Alternate or 3rd Party EVV Systems for Home Health and Hospice Providers 

The EVV requirement deadline for Section 40 Home Health providers and Section 43 Hospice Services providers is January 1, 2023. 

• Read more about Claims Export Issue on the Health PAS Portal, CR 108606   

Some providers have reported errors when attempting to export claims to Excel from the Health PAS Online Portal. This is due to an issue where wide date parameters in the claims search are timing out during the export to Excel process. This is being resolved and providers will be notified once a fix is in the system.    

• Read more about Seven Topics Related to COVID-19 Vaccines and Vaccine Counseling

The following message contains information on 7 topics related to COVID-19 vaccines and vaccine counseling. They have been combined into one message to limit the number of messages arriving in provider inboxes. Not all information pertains to all providers. The following messages are included: 

Aug 8, 2022

The Maine Department of Health and Human Services (DHHS) has implemented a slate of MaineCare rate changes that improve the health and well-being of patients but have been historically underfunded. These changes, which took effect July 1, 2022, include a $54 million investment into cost-effective services tied to Medicare reimbursement and cut across nine MaineCare service areas from physical and occupational therapy to primary care. These rate adjustments will be updated annually, maintaining alignment of MaineCare rates with federal Medicare rates.

• Read more about DHHS Implements $54 Million Investment in New MaineCare Rates

• Read more about MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 93, Opioid Health Home Services, and Chapter III, Section 93, Reimbursement for Opioid Health Home Services

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 Home and Community Based Services (HCBS) Innovation Grants Funding Opportunity 

The Maine Department of Health and Human Services is seeking applications for innovative pilot projects in alignment with Home and Community Based Services (HCBS) to promote greater opportunities for independence and integration in community life for HCBS waiver program members. The Department may award project grants of up to $500,000 to successful applicants. Applications are due by November 8, 2022.

• Read more about Rate Determination Initiation Notice for Section 26, Day Health Services

This e-message provides notice that the Department is initiating a Rate Determination Process* for Section 26 (Day Health Services) of the MaineCare Benefits Manual.  New rates are being determined pursuant to section AAAA-6 of Public Law 2021 Chapter 398, which requires that effective 1/1/23 “the labor portion of the reimbursement rates for essential support workers as defined in Title 22, section 7401, subsection 3 to equal at least 125% of the minimum wage.”