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Payments will help facilities address rising costs and workforce challenges
AUGUSTA – The Maine Department of Health and Human Services (DHHS) announced today that it has issued $30 million in one-time Medicaid (MaineCare) payments to Maine nursing facilities to help them address unforeseen increases in staffing and other operating expenses in the wake of the pandemic.
This is a reminder that the attending provider is required on all UB-04 and 837I claims. MaineCare denies UB-04 and 837I claims submitted without an enrolled attending provider.
The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).
The materials on this page were developed by the Office of MaineCare Services for anyone who wishes to give out information about MaineCare. Materials may be downloaded and many are available in several languages. If you have any questions, please reach out to the MaineCare Communications Team at Communications.MaineCare@maine.gov.
Per the Affordable Care Act (ACA), Section 6401, all providers need to revalidate with all states they are enrolled with.
Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidation began in January 2022.
The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by CMS to conduct program oversight, administration, and integrity.
As previously announced, and in alignment with the SPT repeal enacted in P.L. 2023, Chapter 412, Part XXX, (PDF), the Department will remove all documented add-on amounts associated with the service provider tax for MaineCare reimbursements, effective January 1, 2025.
Notice of Agency Waiver Amendment
AGENCY: Department of Health and Human Services, MaineCare Services
RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 20, Home and Community Based Services for Adults with Other Related Conditions
WAIVER: ME.0995: Home and Community Based Services for Adults with Other Related Conditions
As previously noticed, MaineCare and its vendor are hosting several engagement sessions with interested parties to obtain important feedback as part of the rate determination process that was initiated in June of 2024, for certain HCBS services.
Effective August 1, 2024, or August 6, 2024, MaineCare updated the seasonal flu codes in alignment with the Centers for Medicaid Services (CMS). Please see the table below for the new codes and rates, as well as previous codes that are now end dated. The MaineCare Usual Customary Rates (UCR) Fee Schedule will be updated to reflect this information in the coming weeks.
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