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The Department adopted emergency routine technical amendments to its Certification Standards for Persons Conducting Chemical Analyses for the Detection and Identification of Drugs Rule to reduce the State’s backlog of forensic tests by updating qualifications required of certified lab analysts to immediately address laboratory capacity.
The Centers for Medicare & Medicaid Services’ (CMS) quarterly updates are complete in MIHMS.
The following dates indicate when the CRs are effective in MIHMS:
DRG CRs:
October 26, 2024: 127722 and 127723
November 26, 2024: 128406
APC CRs
November 23, 2024: 128150 and 128151–
The following DRGs are effective in MIHMS as of October 01, 2024:
The Office of MaineCare Services requested a system update that changed the Psychiatric and SUD pricing methodology for hospitals with distinct units in error. This affected claims with dates of service from October 01, 2024, through December 06, 2024. No provider action is needed as MaineCare will adjust affected claims .
For questions, please contact Tiffany Norton, Provider Relations Specialist.
This notice contains guidance for providers delivering the services covered in MaineCare Benefits Manual (MBM) Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations.
BCBA Services No Longer Separately Billable
Effective January 1, 2025, as addressed in P.L. 2023, ch. 643, Part JJ, Acute Care Critical Access Hospitals will no longer be subject to the in-state hospital tax.
Additionally, MaineCare will implement the following reimbursement methodology changes for CAHs, effective January 1, 2025:
Effective January 1, 2025, MaineCare will implement its second phase of changes to our outlier payment methodology and update the hospital-specific Cost to Charge Ratios (CCRs).
Phase 2 changes to the methodology include:
In accordance with the Performance-Based Adjustments rule provision of the MaineMOM rate methodology, MaineCare is adjusting the Per Member Per Month (PMPM) reimbursement rates to reflect a 4% withhold.
Effective January 1, 2025, we will implement the new rates to align with the billing cycle for MaineMOM providers.
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Chapter III, Section 67
NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment to address changes in reimbursement methodologies for Nursing Facilities.
In April 2024, the Centers for Medicare & Medicaid Services (CMS) introduced the Ensuring Access to Medicaid Services Rule, known as the Access Rule. This new rule is designed to make it easier for people to access HCBS and to improve the quality of these services. We are committed to the goals of the Access Rule and beginning to plan for how to meet these new requirements. Over the coming months, we will ask for your feedback about how we implement the requirements.
The Centers for Medicare & Medicaid Services (CMS) issued updated guidance on the use of 340B modifiers for providers and suppliers participating in the 340B Drug Pricing Program and who bill separately for payable Part B drugs and biologicals.
Effective January 1, 2025, providers must use the TB modifier on all 340B drugs provided to MaineCare members whether billing MaineCare for primary or secondary claims.