• Read more about Taxonomy Code Requested on Claim Submissions

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 and helping the Centers for Medicare & Medicaid Services (CMS) conduct program oversight, administration, and integrity.  

• Read more about Section 45, Hospital Service Providers: Public Forum Draft Reimbursement Methods

On December 11, 2023, MaineCare in coordination with its vendor Burns and Associates, a Division of Health Management Associates (HMA-Burns), hosted a virtual public forum via Zoom for interested providers and stakeholders. We presented an initial recommended draft reimbursement methodology and rationale for inpatient services in acute care and rehabilitative hospitals.  

• Read more about ​Standing Order for Dispensing COVID-19 At Home Tests to MaineCare Beneficiaries

MaineCare covers Food and Drug Administration (FDA) approved and FDA Emergency Use Authorized (EUA) over the counter (OTC) COVID-19 home tests through a Standing Order for MaineCare beneficiaries. COVID-19 tests will be covered with no member cost sharing.     

• Read more about ​Primary Care Plus (PCPlus) and Community Health Worker Overview Webinar​

MaineCare, in collaboration with Maine Center for Disease Control, is hosting a webinar focusing on the collaboration between PCPlus practices and Community Health Workers (CHWs) or Community-Based Organizations (CBOs) employing CHWs. The goal of this webinar is to:  

• Provide a brief overview of the CHW workforce in Maine   

• Provide an overview of incentives within PCPlus to increase access to CHW services  

• Read more about ​Updated January 1, 2023 Behavioral Health Rate Adjustments FAQs Regarding Assertive Community Treatment (ACT)

In response to provider inquiries regarding ACT, the Department updated the January 1, 2023 Behavioral Health Rate Adjustments Frequently Asked Questions. 

For questions, please contact provider relations specialist, Bruce Cosgrove.

• Read more about ​Updated Billing Guidance for the Alternate Payment Methodology (APM) for Federally Qualified Health Centers (FQHC)

On May 1, 2023, the Office of MaineCare Services (OMS) released guidance related to billing and implementation of the updated APM for FQHCs.

• Read more about Section 101, Medical Imaging Services: Medicare Standardization Rates Implemented for Calendar Year 2024 (CY24) CR 122712 ​

In follow up to our January 19, 2024 notice, service codes and rates for Section 101, of the MaineCare Benefits Manual are now implemented, effective January 1, 2024, to reflect 72.4% of the most recent 2024 Medicare rates.  

Adjustment of Claims 

• Read more about Department of Health and Human Services to Deliver Recruitment and Retention Payments to Child Welfare Staff This Month

Department also unveils more details about plan from Governor’s State of the State to improve child safety, announcing that the forthcoming supplemental budget will include nearly $7 million in initiatives to strengthen child welfare system

• Read more about ​Attention Section 50, Intermediate Care Facilities: Reprocessing of Day Habilitation Claims - CR 122772              

It has been brought to the Department’s attention that the Section 50, Day Habilitation rate effective January 1, 2024, was not implemented on January 1, 2024, as was previously noticed.  

The updated rate for Day Habilitation (0907) has now been implemented as of February 7, 2024. 

Adjustment of Claims 

• Read more about Maine DHHS and Maine Hospital Association Announce Agreement to Improve Reimbursement & Support Health of Maine People Through MaineCare Rate Reform

$90 Million Investment in Evidence-Based MaineCare Payment System Would Maintain or Increase Payments to Every Medical Center in Maine & Improve Care for Maine People

AUGUSTA— Today, the Maine Department of Health and Human Services (DHHS) and the Maine Hospital Association announced an agreement to reform hospital reimbursement rates to improve the health of Maine people.