• Read more about Rate Determination Initiation Notice for Sections 14, 30, 31, 45, 90, & 103: Certain Medicare Covered Family Planning Services and Long-Acting Reversible Contraception (LARCs)

This bulletin provides notice that the Department has initiated a Rate Determination Process* for certain Medicare covered Family Planning Services and for LARCs. The Department is conducting this rate determination to maintain member access to Family Planning Services. The Department will assess, and determine as appropriate, new rate amounts or reimbursement models in accordance with requirements found in Title 22 MRSA §3173-J. 

• Read more about New - Provider Portal Remit Report for Manual Invoices and Recoupments, CR 101792

A new report is now available to providers on the Health PAS Online Portal. The report is intended to be a supplement to the existing RA/835 which provides more information on the non-claim and reversal recoupment transactions associated with providers payment remit.

To get to the new report:

• Read more about MaineCare Provider Enrollment Progress Update

Gainwell continues to reduce the processing time for enrollment cases. Gainwell completed 572 enrollment cases in April and the average turnaround time for case completion was approximately 16.4 days. Case inventory was 520 at the end of April and the average system age of an enrollment case was approximately 19 days old.  

• Read more about Taxonomy Code Requested on Claim Submissions – Portal Claims

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.  

• Read more about Dental Surgeries in Ambulatory Surgical Centers

On May 13, 2024 the Offices of MaineCare Services (OMS) sent an e-message regarding dental surgery services provided in an Ambulatory Surgical Center (ASC). This message is meant to clarify how the addition of these codes to the MaineCare Benefits Manual (MBM), Chapter II, Section 4, Ambulatory Surgical Centers Fee Schedule is applicable when provided to MaineCare members.

• Read more about Section 93, Opioid Health Home Services (OHH), Cost of Living Adjustment (COLA) - CR 125032

MaineCare is increasing reimbursement rates for Section 93, OHH services, through a COLA as directed by MRS Title 22, §3173-J (referred to as ‘Rate Reform Statute’). The COLA will be effective June 21, 2024, to align with the billing cycle for OHH providers.

• Read more about Provider Training Survey Reminder

Do you or your office need training on MaineCare policy, billing, document requirements and submission, authorizations, the system, or something else? Help us design our future training curriculum! Please complete this short survey to tell us which topics you’re interested in learning more about by May 30, 2024.

• Read more about Maine Clinician Survey on Hepatitis C Treatment

The Maine Center for Disease Control and Prevention (Maine CDC) is working to develop an up-to-date list of practices and healthcare providers who are prescribing and accepting referrals for hepatitis C (HCV) treatment.

The Maine CDC intends to work toward ensuring that treatment is readily available to all patients who test positive for hepatitis C infection. To do this, the Maine CDC is interested in learning about the barriers healthcare providers in Maine are facing in treating hepatitis C, and how the Maine CDC might assist with overcoming these barriers.

• Read more about Maine DHHS Recognizes May as Mental Health Awareness Month

AUGUSTA— The Maine Department of Health and Human Services’ (DHHS) Office of Behavioral Health (OBH) is recognizing May as Mental Health Awareness Month, a time to promote the importance of mental health, reduce stigma, and spotlight resources for support.

• Read more about 10-144 CMR Ch 129, Personal Care Agency Licensing Rule

This routine technical rulemaking operationalizes the statutory requirements of PL 2023 Ch. 309, An Act to Authorize the Department of Health and Human Services to License and Ensure the Quality of Personal Care Agencies.  This rulemaking repeals and replaces 10-144 CMR Ch. 129, Rules and Regulations Governing In-Home Personal Care and Support Workers, which became effective on January 1, 1999.