• Read more about Taxonomy Code Requested on Claim Submissions – Portal Claims

The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by  CMS to conduct program oversight, administration, and integrity.  

• Read more about Revalidate with MaineCare to Avoid Claim Denials

Per the Affordable Care Act (ACA), Section 6401, all providers need to revalidate with all states they are enrolled with.

Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidation began in January 2022.  

• Read more about Rescheduled: Section 107, Psychiatric Residential Treatment Facilities (PRTFs): Revised Draft Rates Public Review and Comment Forum

The PRTF public review and comment forum has been rescheduled to December 17, 2024.  

MEETING DATE & TIME:  

Tuesday, December 17, 2024, 11:30AM – 1:00PM  

ZOOM Information: 

 https://mainestate.zoom.us/j/89397750850

Meeting ID: 893 9775 0850

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• Read more about MaineCare Cost-of-Living Adjustments and Service Provider Tax (SPT) Repeal Update

Cost-of-Living Adjustments (COLA) 

Due to current projected budget limitations, the Department will only be applying COLAs on January 1, 2025, that are required by federal law. Other COLA adjustments will be reliant on additional appropriations by the legislature. 

SPT 

• Read more about DHHS By the Numbers

• Read more about Maine’s Children & Youth with Special Health Care Needs Webinar Learning Series: Childhood Lead Poisoning and Prevention

The Maine CDC Children and Youth with Special Health Care Needs is hosting Dr. Maggie Bordeaux of the Maine CDC Lead Program and invite you to join an insightful webinar on the effects of lead on children; children who are at risk for lead exposure, and ways to prevent lead exposure.

At the end of this presentation, participants will be able to:

• Read more about Update to the Biosimilar Preferred Drug List (PDL)

Effective January 1, 2025, the Department will add preferred and non-preferred drugs to the Biosimilar PDL, listed below.

Preferred drugs:  

• Q5108 – Fulphila, pegfilgrastim-jmdb 

Non-preferred drugs:  

• Read more about Attention Pharmacy Providers Under Title 5

Pharmacy providers whose pharmacy license is under a Title 5 review may use your Title 5 notice to extend your enrollment with MaineCare in MIHMS by six months, and for every six months thereafter, until the Title 5 review is resolved.

• Read more about Rate Determination Initiation Notice for Section 80, Pharmacy Services : Dispensing Fees

The Department has initiated a Rate Determination Process for Dispensing Fees under Section 80 of the MaineCare Benefits Manual.* Maine, along with several other New England states (CT, VT, NH, RI), are participating in an initiative through New England States Consortium Systems Organization (NESCSO) to develop a reimbursement methodology for pharmacy dispensing fees. NESCSO is a non-profit organization governed by the New England State Health and Human Services agencies and the University of Massachusetts Medical School.

• Read more about Section 67, Nursing Facility (NF) Services - Final Draft Rates and Methodologies Comment Summary

An updated summary of all comments resulting from both the March and October 2024 forums is available on the MaineCare Rate System Reform webpage.