• Read more about Rate Determination Initiation Notice for Section 80, Pharmacy Services : Dispensing Fees

The Department has initiated a Rate Determination Process for Dispensing Fees under Section 80 of the MaineCare Benefits Manual.* Maine, along with several other New England states (CT, VT, NH, RI), are participating in an initiative through New England States Consortium Systems Organization (NESCSO) to develop a reimbursement methodology for pharmacy dispensing fees. NESCSO is a non-profit organization governed by the New England State Health and Human Services agencies and the University of Massachusetts Medical School.

• Read more about Section 67, Nursing Facility (NF) Services - Final Draft Rates and Methodologies Comment Summary

An updated summary of all comments resulting from both the March and October 2024 forums is available on the MaineCare Rate System Reform webpage.

• Read more about Retro Physician Drug Rate Updates: Effective October 1, 2023, through September 30, 2024, CR 127535

The Department updated multiple physician drug codes retroactively due to a rate update from the Centers for Medicare & Medicaid Services’ (CMS). These new rates were implemented on October 23, 2024. 

See the table below for the effective dates and new rates. 

• Read more about Quarterly Physician Drug Code Update: Quarter 4, CR 128318

Effective October 1, 2024, in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, the Department  retroactively updated the Physician Drug Rates. On November 20, 2024, the new rates were implemented for billing, and we then processed claims submitted on or after November 20, 2024, at the new rates.

• Read more about Seasonal Flu Codes Added for Hospitals, CR 127605

Effective August 1, 2024, MaineCare updated the seasonal flu codes and rates for hospitals in alignment with the Centers for Medicaid Services (CMS). The new codes are now available for billing. No provider action is required as we will reprocess claims that denied in error.

See the notice from September 6, 2024, for the seasonal flu codes.

• Read more about SNAP 236A - FFY25 Budgeting Figures

10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules -Section 999-3

Rule #236A – FFY25 Budgeting Figures

• Read more about SNAP Rule #234A - ABAWD Geographic Exemptions

10-144 C.M.R. Ch. 301; Supplemental Nutrition Assistance Program (SNAP) Rules - Section 999-2

SNAP Rule #234A – ABAWD Geographic Exemptions

• Read more about Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment

• Read more about OBH Rulemaking Public Comment Form

There are currently no proposed rules open for public comment.

• Read more about Certified Community Behavioral Health Clinics (CCBHC) Comment Deadline Extension

MaineCare is extending the deadline for written comments on the CCBHC Medicaid Demonstration draft rate methodology to November 22, 2024, by 11:00 AM. Please see the presented materials notice that followed the public forum, for more information. Comments should be submitted to RateReform.OMS@maine.gov.