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On February 14, 2025, MaineCare held an online public meeting to present draft rates and models along with the rationale for PNMI, Appendix D, Temporary High Intensity Services. Interested parties had the opportunity to provide public comments.
MaineCare identified and corrected an error in the MaineCare Dental Metrics reporting.
Due to a data filtering error, previous publications of the MaineCare Dental Metrics Report excluded rendering providers in instances where the billing provider is also the rendering provider on the claim, resulting in understated counts of dental rendering providers.
Pursuant to Rate Reform law (MRS Title 22, 3173-J), MaineCare will host our Annual Draft Rate Determination Schedule Consultation with the TAP on March 14, 2025, from 1:00 PM to 2:30 PM via Zoom. This meeting is open to the public. There will be a limited period of time at the end of the meeting for public comment.
Zoom Meeting
The Department will host an important educational call via Zoom for NF Administrators, Directors of Nursing, and other key members of your Quality Assurance Performance Improvement (QAPI) team on February 19, 2025, from 1:00 - 2:30 PM. The meeting will address quality components of the new NF payment model.
You may register through Zoom.
Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services (DHHS), Office of MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities
PROPOSED RULE NUMBER:
CONCISE SUMMARY:
On February 10, 2025, we shared that, if the Legislature does not pass the Fiscal Year 2025 supplemental budget request to fill the MaineCare shortfall, the Department will not have sufficient funds to pay MaineCare providers in full through the end of the fiscal year and will need to temporarily withhold
If your organization is going through an organizational change, please contact Gainwell to receive guidance before beginning an enrollment/revalidation/re-enrollment application or maintenance case and prior to submitting the Disclosure of Organizational Change for MaineCare form. This allows Gainwell/MaineCare to review the change and decide what is the best way the provider needs to enroll or update their enrollment.
Please contact the MaineCare Enrollment email box with questions.
All errors found during a PERM audit are considered improper payments.Maine is required to reimburse the federal government for all improper payments and has the right to seek recoupment from providers for improper payments resulting from provider error.
The most common errors found in the RY 2024 PERM Audit cycle are listed below. The most common errors from the previous two PERM cycles are also included in the list. Before submitting a claim, check that the information for the member and the services provided are accurate and complete.
It has come to our attention that not everyone who signed up for e-messages are receiving the notices we send through the General, All Services distribution list. We are working to resolve this issue. In the meantime, we are resending the e-message we sent on February 10, 2025.
The Department is proposing this routine technical rule change to amend Chapter 266, to coincide with the expiration of the emergency rule effective January 2, 2025, ensuring competency requirements and accreditation standards remain the standard for labs analyzing controlled substances seized by law enforcement and used in Maine’s courts’ procedures. The proposed non-emergency rule changes incorporate those emergency changes adopted by emergency rule to update the oversight authority and certification standards, including the educational and training requirements.