• Read more about MaineCare in Education: Instructions for Providers of Section 28 and Section 96 Services Experiencing Difficulties with Modifier Guidance for Education-related Services 

On May 17, 2022, MaineCare issued billing guidance, MaineCare in Education: New Modifier Guidance for Sections 28 and 96, that all providers submitting claims for Individuals with Disabilities Education Act (IDEA) services delivered under Section 28 or Section 96 of the MaineCare Benefit Manual should include the TL or TM modifier on the claim line to indicate if the service w

• Read more about Attention Section 90 Providers: Upcoming Changes for Billing Topical Fluoride Varnish 

On August 22, 2022, the Department will remove Dental Procedures and Nomenclature (CDT) code D1206, Topical Application of Fluoride Varnish, from non-dental provider contracts so that it is no longer billable by non-dental providers. This change is part of the rulemaking for MaineCare Benefits Manual, Chapter II, Section 90, Physician Services, which was adopted on May 9, 2022.       

• Read more about MaineCare’s HOME Provider Orientation Webinar Dates and Application Opening on July 22, 2022   

HOME Services Provider Orientation

Effective July, 22, 2022, MaineCare is accepting Housing Outreach and Member Engagement (HOME) Provider applications from providers interested in delivering HOME services for eligible individuals experiencing long-term homelessness, as described in the newly adopted MaineCare

Jul 7, 2022

The Office of MaineCare Services has launched Primary Care Plus (PCPlus), a new initiative to support primary health care, advance health care quality, and improve the efficiency of health care spending. PCPlus enables MaineCare to replace the prior outdated and convoluted system of payments and offer primary care practices a single, integrated process for reimbursement with greater flexibility and incentives to meet MaineCare members’ health care needs. 

• Read more about MaineCare Launches New Payment Model to Improve Primary Care Services

• Read more about Drug Rate Updates

Additional 2021 Drug Rate Updates, CR 106867 

On January 12, 2022, we updated certain drug code rates retroactively to either January 1, 2021, or July 1, 2021, in MIHMS based on updates from the Centers for Medicare & Medicaid Services (CMS).  

• Read more about Rate Update for 2022 Ambulatory Surgical Centers (ASC) Rates, CR 107519 

On February 10, 2022, as part of a regular annual update, we updated the rates for MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services, in MIHMS retroactively to January 1, 2022.  

• Read more about MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter II, Section 25 (repeal); Chapter III, Section 25 (repeal) and Chapter II, Section 25, Dental Services and Reimbursement Methodology (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 proposed

• Read more about Office of Aging and Disability Services Virtual Listening Session to Access Technology for Individuals with Intellectual and Developmental Disabilities 

The Department of Health and Human Services (DHHS) Office of Aging and Disability Services (OADS) is hosting a virtual listening session to gather input on Supporting Access to Technology by Individuals with Intellectual and Developmental Disabilities (IDD).

• Read more about Alternate Electronic Visit Verification (Alt EVV) Specification Requirement 

We published an updated Alternate Electronic Visit Verification Specification document on the Health PAS Online Portal, called “EVV Requirement Specification.” This document is for providers using an alternate/third-party vendor to meet EVV requirements.  

• Read more about Attention Specialty Providers: Primary Care Plus (PCPlus) Impact on Referrals  

Effective July 1, 2022, Primary Care Plus (PCPlus) is MaineCare’s new value-based approach to support the primary care system, improve healthcare quality, and reduce inefficient health care spending. PCPlus replaces MaineCare’s former primary care programs, including Primary Care Case Management (PCCM), Primary Care Provider Incentive Payment (PCPIP), and primary care Health Homes, with a single, integrated initiative.