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The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, Office of MaineCare Services
CHAPTER NUMBER AND TITLE:
10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services: EMERGENCY RULE
ADOPTED RULE NUMBER:
Findings of Emergency:
In alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, we retroactively updated the Physician Drug Rates to July 1, 2025. We implemented these new rates for billing on August 13, 2025.
On September 11, 2025, the Department will present updates to the previously proposed final draft rates and models for Sections 18, 20, 21, 29, and the New Lifespan Waiver. The updates follow comments received from the public on the draft rates and models presented on April 14, 2025.
Aug 8, 2025
The Maine Center for Disease Control and Prevention (Maine CDC), in collaboration with scientists from Maine's Department of Agriculture, Conservation and Forestry and the Environment Protection Authority Victoria (EPA Victoria) in Australia recently published a scientific article in Toxics about per- and polyfluoroalkyl substances (PFAS). This study advances the ability to predict the transfer of PFAS from soil to livestock feed and then to beef cattle.
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).
It is important for your TPA administrator to actively manage your user accounts for the Health PAS Online Portal. To manage users, log into the administrator TPA and click on “Account Maintenance” and then “Manage Users.” Edit existing, deactivated or reactivated users by clicking on the row of the user you would like to manage. The Administrator of the account and users with a security role of “R7-User Management” are allowed to use these features.
Maine CDC warns of risk of disease from mosquitoes, including during dry weather
AUGUSTA-- The Maine Department of Health and Human Services' Maine Center for Disease Control and Prevention (Maine CDC) announced today that mosquitoes in the Cumberland County city of Portland tested positive for West Nile virus (WNV).
Public Review & Comment
On September 3, 2025, at 9:00 AM, the Department with our vendor, Guidehouse Inc. will host a public forum, to present the recommended draft rates and rate models in addition to rationale for NF Specialty Units under Section 67 of the MaineCare Benefits Manual. Following the forum, interested parties will have the opportunity to provide public comments.
At this forum, the Department will also provide an update on Phase I of NF rate reform as it relates to the VBP requirements.
Presenters needed for the Forum Dates & Locations:
MaineCare is once again inviting you to submit presentation proposals this year!