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You may be aware that Optum Change Healthcare is experiencing a network interruption related to a cyber security issue. This is a national issue affecting Medicaid members in many states, including Maine. As a result, MaineCare is experiencing issues processing pharmacy claims.
As part of the Department’s reimbursement reform efforts, MaineCare initiated a rate determination in June of last year, for Section 67, Nursing Facilities and Section 97, Appendix C, Residential Care Facilities.
Feb 2, 2024
Today, the Maine Department of Health and Human Services (DHHS) released the framework (PDF) for MaineCare (Maine Medicaid) nursing facility rate reform for fiscal year 2025, which will support the direct care workforce, incentivize permanent staff, and promote quality care and positive health outcomes for Maine residents who live in nursing facilities.
As noted in our previous e-message, Change Healthcare is experiencing a network interruption related to a cyber security issue. This is a national issue affecting Medicaid members in many states. As part of the impacts of these technical issues, we are not able to process retail pharmacy claims until further notice.
In follow up to our January 19, 2024 notice, service codes and rates for Sections 68 and 85 of the MaineCare Benefits Manual, effective January 1, 2024, are now implemented to reflect 72.4% of the most recent 2024 Medicare rates.
Adjustment of Claims
You may be aware that Change Healthcare is experiencing a network interruption related to a cyber security issue. As a result, MaineCare is experiencing intermittent network issues processing claims. If you experience issues with claims, please follow your routine offline claims processing procedures. We are working to gather more details about the impacts and determine a timeline for resolving these issues and will return to normal business as soon as possible.
On September 8, 2023, in partnership with the Maine Center for Disease Control and prevention, MaineCare authorized a standing order for licensed pharmacists to create a single use prescription for OTC naloxone two dose nasal spray kit. This standing order can be accessed on the MaineCare website in the Provider Resources section under the Pharmacy header.
As previously shared in our October 31, 2023 provider bulletin, certain Appendix K flexibilities for sections 18, 21, and 29 have continued beyond November 11, 2023. The Centers for Medicare & Medicaid Services (CMS) plans to approve the corresponding 1915(c) waiver amendments necessary to make these changes permanent effective March 1, 2024.
Effective February 10, 2024, the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates are complete in MIHMS. The following CMS documents provide the details of the APC updates:
https://www.cms.gov/files/document/r12419cp.pdf
This 30-minute live webinar will cover updates from Maine State Housing Authority and the MaineCare Housing Outreach and Member Engagement (HOME) programs. A recording will be posted on MaineCare’s website. Register for the webinar. We look forward to seeing you there!
Please contact Emily Bean with questions.