MaineCare Bulletins

Date Title Topic
RESCHEDULED: Primary Care Plus (PCPlus) Model Advancement Kickoff Meeting and PCPlus Phase II Alternative Payment Model (APM) Design Kick-off Meeting Primary Care and Care Coordination
MaineCare Benefits Manual (MBM), Chapter VI, Section 3, Primary Care Plus (PCPlus) – Rate Determination Kickoff Meeting & Primary Care Utilization Review Meeting General, All Services, Primary Care and Care Coordination
MaineCare Notice of Agency Waiver Renewal State & Federal Policy
Tips and Tricks for Password and Username Resets on the Health PAS Online Portal, CR 131667 General, All Services
Guidance for Section 65 Medication Management Code Changes and Duplication with Intensive Outpatient Programs (IOP) Behavioral Health (BH)
New Health PAS Online Portal Downtimes Critical Communications
Section 65, Mobile Crisis Intervention Response Services – Final Draft Rate Model Presented Materials, Comment Summary with Department Response, and Final Draft Rates Behavioral Health (BH)
Billing Requirement for the Emergency Services Limited Benefit Package Hospital & Clinic Services
Prescribing Providers Must Enroll in MaineCare Dental Services, General, All Services
Section 97, Appendix C, Residential Care Facilities (RCFs): Implementation of Part AAAA Adjustment Long Term Care Services
Section 50, Intermediate Care Facilities (ICF) Rate Letters for Fiscal Year 2026 (FY26) and Day Habilitation Service Rate Update – CR 133180 Long Term Care Services
Sections 21 & 29: July 1, 2025, Cost-of-Living Adjustments (COLAs) Implemented Long Term Services and Supports
Primary Care Plus (PCPlus) Model Advancement Meeting Primary Care and Care Coordination
Attention Providers: System Maintenance Disrupting Provider Maintenance Cases General, All Services
Sections 18, 20 & 65: July 1, 2025, Cost-of-Living Adjustments (COLAs) Implemented Behavioral Health (BH), Long Term Services and Supports
System Maintenance Complete and Provider Maintenance Cases Resume General, All Services
MaineCare Provider Training Opportunities General, All Services
Disclosures of Organizational Change Reminder General, All Services
Section 31, Federally Qualified Health Centers (FQHCs) Retroactive Cost-of-Living Adjustment (COLA) Primary Care and Care Coordination
Sections 91 & 93: Health Home Services - Community Care Teams (91) and Opioid Health Home Services (93) – Cost-of Living Adjustments (COLAs) Behavioral Health (BH)
Section 45 Hospitals: Cost-of-Living Adjustments (COLAs) Hospital & Clinic Services
Section 97, Appendix C, Residential Care Facilities (RCFs) Cost-of-Living (COLA) & AAAA Adjustments Long Term Care Services
Sections 23, 25, 30, 40, 89, 91, 93, 97 B & D, 102: July Cost-of-Living Adjustments (COLAs) General, All Services
Status of 1.95% Cost-of-Living Adjustments (COLAs) for Sections 2,12,13,17,18,19, 20, 21, 26, 28, 29, 65, 96, 97C General, All Services
Final Rate Model: Section 65, Mobile Crisis Intervention Response Service Behavioral Health (BH)
Rate Determination Initiation Notice: New Section, 106 School Health-Related Services and New Service, Section 65 Multi-Dimensional Family Therapy (MDFT) General, All Services
Primary Care Plus (PCPlus) Model Advancement Meeting Primary Care and Care Coordination
Final Rate Determination Schedule Calendar Year 2025 (CY25) and Comment Summary General, All Services
Section 97, Private Non-Medical Institutions, Appendix F (PNMI-F): Rate Letters for Fiscal Year (FY) 2026, CR,132604 Long Term Care Services
Rounding Rule Clarification General, All Services
MaineCare Issued Annual Hospital Value-Based Purchasing (VBP) Supplemental Payments Hospital & Clinic Services
Attention MaineCare Providers: Plans to Release Payments Pended During Temporary MaineCare Payment Holds – June 16, 2025 Critical Communications
Billing Reminder: When Services are Rendered Via Telehealth Critical Communications, Behavioral Health (BH), Dental Services, General, All Services, Hospital, Family Planning, and Ambulatory Care/Clinic Services, Hospital & Clinic Services, Long Term Care Services, Long Term Services and Supports, Primary Care and Care Coordination, School Health Related Services, Specialty Services
Licensing Requirements for ​Intensive Outpatient Program (IOP) Providers Behavioral Health (BH)
Section 92, Behavioral Health Homes (BHH) Cost-of-Living Adjustments (COLA) Behavioral Health (BH)
​2025 Home and Community Based Services (HCBS) Consumer Assessment of Healthcare Providers & Systems (CAHPS®) Survey​ Long Term Services and Supports
MaineCare Cost of Living Adjustments (COLAs) for Sections 12, 13, 17, 18, 19, 20, 21, 26, 28, 29, 65, 92, 96, and 97C General, All Services
Prescribing Providers Must Enroll in MaineCare Dental Services, General, All Services
Provider Responsibility for Managing Users in my Health PAS Trading Partner Accounts (TPA) General, All Services
Taxonomy Code Requested on Claim Submissions – Portal Claims General, All Services
Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840 General, All Services
Prescribing Providers Must Enroll in MaineCare General, All Services
Clarifications to Section 65 Medication Management Code Changes Behavioral Health (BH)
Revalidate with MaineCare to Avoid Claim Denials General, All Services
Microdyn Update for Ambulatory Payment Classifications (APC) and Diagnostic Related Groups (DRG) - CRs 131553, 131554, & 131582 Hospital & Clinic Services
Quarterly Physician Drug Code and Rate Update: QTR 2, CR 131894 Hospital & Clinic Services
Section 65 Medication Management Code Changes Behavioral Health (BH)
Updated Secondary Billing Instructions General, All Services
Reminder: Providers Delivering Services Via Telehealth General, All Services, Retail Pharmacies
Payment Error Rate Measurement (PERM) Reporting Year (RY) 2024 Errors General, All Services