Primary Care Plus (PCPlus) Update on Quality Measures and Performance-Based Adjustments

PCPlus providers will receive their first quality performance reports in April 2023. These reports aggregate performance at the practice level for available measures. Providers will receive these initial reports via email through the contact listed in their PCPlus application. If you need to update your practice contact information, please email PCP-Network-Services.DHHS@maine.gov.        

Attention Providers of Section 50, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) Services: Implementation of January 1, 2023, Rate Increases

The Office of MaineCare Services increased the reimbursement rate for the Section 50, Day Habilitation Services (T2021 w/ Rev Code 0907) rate to $8.71 (per 15-minute unit) retroactively to January 1, 2023, in accordance with Chapter III, Section 50 of the MaineCare Benefits Manual which states that the Department shall reimburse Community Support services affiliated with ICF-IDD services in accordance with reimbursement for Community Supports under Section 21, Chapters II & III, Home and Community Benefits for Memb

End of the Federal Public Health Emergency (PHE) Provider Mailbox

On January 30, 2023, the Biden-Harris Administration announced that the federal COVID-19 PHE will end on May 11, 2023. The Department is diligently reviewing all PHE-related flexibilities and is developing guidance to clearly articulate what flexibilities will end, along with associated timeframes. We plan to update our website resources and send out additional e-messages over the coming weeks and months.

10-144 C.M.R. Chapter 332; MaineCare Eligibility Manual, Chart 4.3, Rule #302 - Penalty Divisor Rule

This proposed rule updates the average nursing care private rate, listed in Chart 4.3 of the MaineCare Eligibility Manual, to the most current figure available from the Department's internal audit team. Effective June 1, 2023, the average nursing care private rate is determined from rates reported by nursing facilities on the MaineCare Cost Report. The rule also adds a description of how the rate is used to calculate penalty periods for disposing of assets for less than fair market value on or after the look-back period.

Attention Providers of Section 31, Federally Qualified Health Centers (FQHC): Draft Rate Methodology Public Review Presented Materials and Comments  

On March 30, 2023, MaineCare held an online public meeting to present a draft Alternative Payment Methodology (APM) along with the rationale for the recommended methodology for section 31, Federally Qualified Health Centers.

Attention Providers of Section 18, 19, 20, 21, and 29 Services: Appendix K to Maine’s Home and Community Based Services (HCBS) Waivers Continues to Provide Temporary Flexibilities on Service Caps and Staffing

Appendix K to Maine’s HCBS 1915(c) waivers provides the state certain flexibilities in waiver program operations during an emergency. Maine’s Appendix K and amendments may be found on Medicaid.gov.

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