MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual, Chapter III, Section 45
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules
Attention Providers of Section 18, 20, 21, 29, Home & Community Based Supports and Proposed Lifespan Waiver: Cost Survey Tool
In September 2023, the Department initiated a rate determination process for Sections 18, 20, 21 and 29, and a newly proposed Lifespan program for individuals with intellectual and developmental disabilities (I/DD).
Maine CDC Urges Vaccination Against Flu, COVID-19, RSV Entering Holiday Season
AUGUSTA – The Maine Center for Disease Control and Prevention (Maine CDC) encourages Maine residents to get vaccinated against COVID-19, influenza (flu), and respiratory syncytial virus (RSV) ahead of this season's holiday gatherings. Vaccination remains the best way for Maine people to protect themselves, their friends, and relatives this holiday season and will help limit the spread of respiratory viruses at gatherings this winter.
Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840
This is a reminder that the attending provider is required on all UB-04 and 837I claims. MaineCare denies UB-04 and 837I claims submitted without an enrolled attending provider.
The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).
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 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
Attention EVV Providers: Inactive Client (Member) Status
Periodically, Sandata may change a client’s status from active to inactive for reasons such as losing MaineCare coverage or no longer receiving personal care, home health, or hospice services.
The default view in the Sandata portal is to show active clients. To see inactive clients, go to Data Entry, then to the status field within the Clients>Search Clients>Status panel. Select “Inactive,” as shown below.
Update to the Biosimilar Preferred Drug List-Correction
On December 1, 2023, the Office of MaineCare Services (OMS) notified providers of the changes to the Biosimilar Preferred Drug List effective January 4, 2024. The notice sent on December 1, 2023, inadvertently omitted the drug class Rituximab.
Attention: New Email Address for Adult Family Care Homes and Private Non-Medical Institutions (PNMI), Level IV, Appendix C
Effective December 4, 2023, there is a new email address for Adult Family Care Homes (Section 2) and PNMI, Level IV, Appendix C facilities (Section 97). The new address is MDS.AH.DHHS@Maine.gov. Please use this address to send questions a facility may have regarding completion or submission of MDS assessments. Please send all correspondence intended for Catherine Gunn or Donna Reed to this email address, including requests for new accounts, reset of passwords, roster questions and training questions.
MaineCare Benefits Manual (MBM), Chapter II, Section 71: National Diabetes Prevention Program (NDPP) Services Provider Enrollment Now Open
As previously announced, on November 8, 2023, the Office of MaineCare Services (OMS) formally adopted MBM, Chapter II, Section 71: NDPP Services.
Attention Hospitals: Instructions for Distinct Psychiatric or Substance Use Disorder (SUD) Billing Now Available, CR 120732
Hospitals that are billing for services provided in Distinct Psychiatric units or Distinct SUD units with a service start date on or after July 1, 2023, should bill for services correctly to receive appropriate reimbursement.