Provider Update: Federally Required MaineCare Off-Cycle Provider Revalidation Plan

On April 23, 2026, the Centers for Medicare & Medicaid Services (CMS) issued letters to all states requesting that they develop and submit a comprehensive two-year provider revalidation strategy, with priority given to revalidating “high-risk” providers. In their letter, CMS additionally urged states to revalidate high-risk provider types more often than lower risk provider types.   

In accordance with federal regulations, Maine’s standard revalidation schedule requires that all MaineCare providers revalidate their information every five years – aside from Durable Medical Equipment (DME) providers, which must revalidate their information every three years.

CMS required states to submit a detailed implementation plan for an off-cycle two-year revalidation strategy by June 5, 2026. Providers can find Maine’s submitted revalidation plan on a new OMS webpage: Federally Required 2026-2028 Off-Cycle Revalidation Plan. (Please note: The submitted plan is subject to CMS review and approval and may be revised based on CMS feedback.)

The Department carefully assessed all provider types and used a risk-based methodology to determine which providers would be included in the off-cycle revalidation plan. Inclusion in this off-cycle revalidation plan does not reflect a determination that a provider has engaged in improper conduct. This assessment considered: provider enrollment screening requirements, information derived from program integrity and oversight activities including federal inquiries, and existing federal and state categorical risk designations, as outlined below:

  • Risk Category Assignments – describes MaineCare provider types and their associated categorical risks levels. Available on the OMS webpage here.
  • MaineCare Benefits Manual (MBM) Chapter I, Section 1.03(J)(2) – describes the provider types designated as “High Categorical Risk” and the circumstances under which individual providers may be elevated to “high risk.”

In alignment with the CMS guidance, some providers who have recently revalidated or newly enrolled will be excluded from this revalidation cycle. The Department will post a revalidation schedule identifying every impacted provider’s revalidation date on the OMS webpage noted above when that is finalized this summer. Providers will also receive written letters in advance of their revalidation date.   

The Department remains committed to program integrity, responsible stewardship, and clear communication with providers throughout this process. We will share information through normal communication channels with providers as applicable and when revalidation in accordance with the plan is required.

For questions regarding the revalidation process or your provider enrollment status, please contact your Provider Relations Specialist.