Text Messaging Not Accepted Method of Substantive Contact for Section 13, Targeted Case Management (TCM) Services

Attention Pharmacy Providers: Status of Restoration of Maine Point of Purchase System (MEPOPS) and Office Hours with MaineCare’s Pharmacy Team

The Office of MaineCare Services continues a phased recovery following the outage that occurred from February 21, 2024, through March 26, 2024, due to the national cyber security issue affecting Change Healthcare. 

Maine’s Children & Youth with Special Health Care Needs Webinar Learning Series: MaineCare in Education

This comprehensive webinar on September 3, 2024, from 3:30-4:30 PM, provides a basic overview of MaineCare services in schools. An explanation of MaineCare eligibility will include what school related services are available, who is eligible and how to access them. Trista Collins will cover Katie Beckett coverage and dispel some myths regarding MaineCare covered services. Participants will learn about MaineCare covered services in an Individual Education Plan (IEP) and how to utilize Private Duty Nursing (PDN) both at home and in the school setting.

Certified Community Behavioral Health Clinic (CCBHC) Certification Documentation Due September 6, 2024

On December 13, 2023, MaineCare noticed the opportunity for an initial cohort of prospective CCBHCs to submit provisional certification materials. The Department is now accepting final certification documentation from provisionally certified providers. The Department will review submissions for final approval and full certification status and participation in Maine’s CCBHC Demonstration program.

​Attention Section 65, Behavioral Health Services Providers: Temporary Claims Payment Delay

Attention Section 65 Providers, Section 65 claims are temporarily pending due to an error in Gainwell’s implementation of the January 1, 2024, COLA. Gainwell corrected the error. Affected claims will process in this week’s reimbursement payment cycle which will issue reimbursements on August 23, 2024.  

MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

Notice of Agency Rule-making Proposal

AGENCY:  Department of Health and Human Services (DHHS), MaineCare Services, Division of Policy

CHAPTER NUMBER AND TITLE:

10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

PROPOSED RULE NUMBER:

CONCISE SUMMARY:

MaineCare Rule #309P - DEL Updates

The proposed rule change would update Section 2, APPLICATION PROCESS, consistent with a legislative change to 22 M.R.S. § 3174-LLL made by P.L. 2023, ch. 412. Effective retroactive to July 1, 2024, individuals who are enrolled in Medicaid and/or Medicare Buy-In (MSP), who are eligible for Medicare Part D, and meet the income criteria in Section 2.2, are deemed to be eligible for and enrolled in DEL. These individuals do not need to file a separate application.

In addition, the proposed rule would make the following changes:

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program for Children and Youth – New Provider Resources Available

MaineCare’s EPSDT program allows MaineCare members under the age of 21 to receive medically necessary services that are not typically covered due to limits on the type, frequency, or duration of the service. These services can include preventive, dental, developmental, behavioral health, and specialty services.

Comprehensive EPSDT program resources are now available for providers:

Subscribe to