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Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual
Dec 12, 2024
Today, the Maine Department of Health and Human Services (DHHS) released an update on the conclusion of MaineCare (Medicaid) eligibility reviews after the COVID-19 Public Health Emergency, known as "unwinding." At the conclusion of the 15-month unwinding period (from May 2023 through October 2024), the Department's efforts have resulted in over 345,000 MaineCare members successfully renewing and retaining coverage.
10-144 C.M.R. Chapter 332; MaineCare Eligibility Manual – Part 2
Part 2, Section 9 Update
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.
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.
Effective January 1, 2025, the Department exercises enforcement discretion permitting providers to utilize telehealth for Section 17 services in line with the following guidance.
PA requests for complete dentures must include ALL of the following:
We will defer PA requests that do not include appropriate documentation and send a letter to the provider.
Effective January 1, 2025, in accordance with the Centers for Medicare & Medicaid Services (CMS) application fee requirements, MaineCare’s provider enrollment application fee will increase to $730 per enrollment application. This increase will apply to new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.
In response to MaineCare provider inquiries regarding SPT repeal, the Department updated the FAQs originally published and shared in the
UPDATE: Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment
AGENCY: Department of Health and Human Services, Office of MaineCare Services
NATURE OF PROPOSED CHANGES: The state is requesting a budget neutrality projection adjustment for two components of the current 1115 Waiver Substance Use Disorder (SUD) Care Initiative.