• Read more about ​Non-Emergent, Emergency Department (ED) Pricing Failure, TR 113880

MaineCare identified an overpayment of some emergency room hospital claims. These claims received the Ambulatory Payment Classifications (APC) rate vs. the non-emergent rate. The affected date range is July 01, 2021, through March 31, 2023. MaineCare will reprocess all affected claims and no provider action is needed. 

• Read more about ​UPDATED Billing Guidance and Claims Reimbursement for Distinct Psychiatric and Substance Use Disorder (SUD) Units

On September 19, 2023, the Office of MaineCare Services (OMS) sent a notice advising hospitals with distinct psychiatric and SUD units that our systems will update to reimburse claims to such units on October 1, 2023, as described in the

• Read more about New Hyaluronic Acid Derivatives Criteria Sheet, CR 119147

MaineCare replaced the Prior Authorization (PA) Synvisc Hyalgan Euflexxa Orthovisc form.  

• Read more about Chapter 101, MaineCare Benefits Manual

Notice of MaineCare Reimbursement Methodology Change

AGENCY: Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual

• Read more about MaineCare Member E-Messages

• Read more about 10-144 C.M.R. Ch. 301 Supplemental Nutrition Assistance Program (SNAP) Manual; Section 999-2

Federal Supplemental Nutrition Assistance Program (SNAP) regulations provide that certain able-bodied adults without dependents (ABAWDs) are subject to a maximum of three months of benefits over a 36-month period, unless they work 20 hours or more per week (averaged monthly) or participate in and comply with requirements of a work program.  Individuals who reside in certain geograp

• Read more about Rules for Conversion of Seasonal Dwelling Units into Year-Round Residences in the Shoreland Zone 10-144 CMR Ch 242

The Department is proposing the repeal of this rule at the same time that it is adopting amendments to Maine's Subsurface Wastewater Disposal Rules, 10-144 CMR Ch. 241 (Ch. 241). The Department has clarified the requirements and updated language within Section 8(B)(1) of Ch. 241, in order to repeal Ch. 242 and to clarify that seasonal conversion permits may only be issued when the structure served by a subsurface wastewater disposal system meets the criteria of first-time systems as described in Section 8, First Time Systems, of Ch. 241. This new language in the newly amended Ch.

• Read more about Certified Community Behavioral Health Clinics (CCBHC), Section To Be Determined: Kickoff Meeting Presented Materials

As previously shared in our June 20, 2023, bulletin, the Department has initiated a rate determination process for CCBHC services.     .     

• Read more about ​ ​Public Forum Postponed: Attention Section 97, Private Non-Medical Institutions (PNMI), Appendix D, Therapeutic Foster Care (TFC) Services: Draft Rate Model Public Review and Comment​

The public review and comment forum that was scheduled for September 29, 2023, to present the draft rates and service model for TFC services has been postponed due to unforeseen circumstances. We appreciate your patience and apologize for any inconvenience. The Department will reschedule this forum at a later date and will send notice of the new date and time. Please watch for future notices. 

• Read more about Attention Providers of Section 18, 20, 21, 29, Home & Community Based Supports for Individuals with Intellectual Developmental Disabilities and Proposed Lifespan Waiver: Amendment to Initiation and Section 21 & 29 Kickoff Meeting Presented Materials

As previously shared in our September 8, 2023, bulletin, the Department has initiated a rate determination process for Sections 21 and 29, and a newly proposed Lifespan waiver service. Please note: although not previously stated, this initiation also includes services in Sections 18 & 20 that align with the services in Sections 21 and 29 being studied under this rate determination.