• Read more about Attention Providers of Section 67 Nursing Facilities (NF) and Section 97, Residential Care Facilities (RCFs, PNMI Appendix C): Provider Rate Methodology Workgroup Presented Materials

MaineCare previously provided notice that we had initiated a rate determination process for Section 67, Nursing Facilities and Section 97, Residential Care Facilities. As part of the rate determination process, MaineCare and our vendor Guidehouse Inc.

• Read more about ​Kepro Behavioral Health Authorizations and Early and Periodic Screening, Diagnostic, and Treatments (EPSDT) Services Awareness​

Kepro reviews clinical documentation submitted with Prior Authorization (PA) and Continued Stay Review (CSR) requests for members under 21 years of age, including requests for behavioral health services. Kepro reviews the documentation for medical necessity of the requested services not only under the service-specific limits of the MaineCare Benefits Manual (MBM), but also under EPSDT guidelines.     

• Read more about Attention Providers of Sections 17, 65, and 92 Adult Behavioral Health Services: Service Termination Approval Requirements

This notice provides clarification to providers of Sections 17, 65, and 92 Adult Behavioral Health Services regarding service termination approval requirements for adults receiving behavioral health services. *There are no changes for Section 97 service termination requests. Section 97 providers should follow the existing process.*   

• Read more about ​Pfizer and Moderna Monovalent COVID-19 Vaccines No Longer Authorized for Use, CR 116981

On April 18, 2023, the Food and Drug Administration (FDA) announced changes to simplify the use of Bivalent mRNA COVID-19 vaccines. As a result, the Monovalent COVID-19 vaccines produced by Pfizer BioN-Tech and Moderna are no longer authorized for use in individuals aged six months and older. See the codes below that are no longer authorized for use:  

• Read more about Service Locator Tool – Invitation to Behavioral Health Providers

The Department of Health and Human Services (DHHS) is excited to announce the creation of a Service Locator Tool hosted on Bamboo Health’s TreatmentConnection.com. The Tool will improve access to treatment for substance use and mental health issues. The goal is to publicly launch this tool in summer 2023. 

• Read more about ​Implementation of January 1, 2023, Rate Study Increases for Section 2, Adult Family Care Homes (AFCH), CR 116777​

As of today, April 19, 2023, updated rates for Section 2, AFCH are now available for billing in MIHMS. These changes will be effective retroactively to January 1, 2023, and are a result of our recent rate study conducted in relation to P.L. 2021 Ch.398, Part AAAA.

• Read more about CoverME.gov Launches Special Enrollment Period for Maine People Transitioning from MaineCare

Individuals losing eligibility for MaineCare can enroll in plans on CoverME.gov through July 31, 2024

• Read more about Clone of COVID-19 & Public Health Emergency (PHE)

• Read more about 10-144 CMR Ch. 241, Maine Subsurface Wastewater Disposal Rules

BRIEF SUMMARY: On December 14, 2022, the Maine CDC proposed amendments to the Maine Subsurface Wastewater Disposal Rule and solicited public comments until January 13, 2023. The Department reviewed and considered all comments received and as a result plans to make additional changes to the rule.

• Read more about Section 2, Adult Family Care Homes (AFCH) – Public Comment Summary with Department Response and Final Draft Rates, CR 116777

In August 2022, the Office of MaineCare Services initiated a rate determination for Section 2, AFCH, with our vendor Burns and Associates and interested stakeholders. We presented our goals for this study and provided an overview of the cost survey. In October 2022, we met with stakeholders to go over the findings of the cost survey and obtain additional feedback.