Feb 2, 2024

The Maine Department of Health and Human Services is prioritizing a comprehensive outreach effort to ensure MaineCare (Medicaid) members know they need to connect with the Department to continue their coverage.

As part of the resumption of eligibility reviews after the COVID-19 Public Health Emergency, known as “unwinding,” the Department is reviewing the eligibility of all MaineCare members. DHHS outreach is focused on make sure members know the steps to take to avoid unnecessarily losing coverage. Efforts include:

• Read more about Maine DHHS reaching out to Maine people to keep them covered

• Read more about Provider Enrollment Presentation Follow-Up and Progress Update

On January 17, 2024, the Office of MaineCare Services (OMS) and Gainwell held a listening session about provider enrollment. During this session, providers asked questions and shared suggestions about how to improve the enrollment, revalidation, and maintenance case submission process and case review process. We appreciate the time that providers took to attend, participate, and share their ideas to improve these processes.

• Read more about Electronic Visit Verification (EVV) Phase 2 Trainings

The EVV requirements for Home Health providers delivering services under Section 40 were implemented on January 1, 2023.

We continue to offer weekly EVV provider and aggregator trainings. All trainings are online via Microsoft Teams.

NOTE: The Absorb training system has been updated to allow providers to register for trainings more than once.

EVV Training Schedule

• Read more about Taxonomy Code Requested on Claim Submissions

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 and helping the Centers for Medicare & Medicaid Services (CMS) conduct program oversight, administration, and integrity.  

• Read more about Section 45, Hospital Service Providers: Public Forum Draft Reimbursement Methods

On December 11, 2023, MaineCare in coordination with its vendor Burns and Associates, a Division of Health Management Associates (HMA-Burns), hosted a virtual public forum via Zoom for interested providers and stakeholders. We presented an initial recommended draft reimbursement methodology and rationale for inpatient services in acute care and rehabilitative hospitals.  

• Read more about ​Standing Order for Dispensing COVID-19 At Home Tests to MaineCare Beneficiaries

MaineCare covers Food and Drug Administration (FDA) approved and FDA Emergency Use Authorized (EUA) over the counter (OTC) COVID-19 home tests through a Standing Order for MaineCare beneficiaries. COVID-19 tests will be covered with no member cost sharing.     

• Read more about ​Primary Care Plus (PCPlus) and Community Health Worker Overview Webinar​

MaineCare, in collaboration with Maine Center for Disease Control, is hosting a webinar focusing on the collaboration between PCPlus practices and Community Health Workers (CHWs) or Community-Based Organizations (CBOs) employing CHWs. The goal of this webinar is to:  

• Provide a brief overview of the CHW workforce in Maine   

• Provide an overview of incentives within PCPlus to increase access to CHW services  

• Read more about ​Updated January 1, 2023 Behavioral Health Rate Adjustments FAQs Regarding Assertive Community Treatment (ACT)

In response to provider inquiries regarding ACT, the Department updated the January 1, 2023 Behavioral Health Rate Adjustments Frequently Asked Questions. 

For questions, please contact provider relations specialist, Bruce Cosgrove.

• Read more about ​Updated Billing Guidance for the Alternate Payment Methodology (APM) for Federally Qualified Health Centers (FQHC)

On May 1, 2023, the Office of MaineCare Services (OMS) released guidance related to billing and implementation of the updated APM for FQHCs.

• Read more about Section 101, Medical Imaging Services: Medicare Standardization Rates Implemented for Calendar Year 2024 (CY24) CR 122712 ​

In follow up to our January 19, 2024 notice, service codes and rates for Section 101, of the MaineCare Benefits Manual are now implemented, effective January 1, 2024, to reflect 72.4% of the most recent 2024 Medicare rates.  

Adjustment of Claims