General Assistance Proposed Rule #26

10-144 C.M.R. Chapter 323; Maine General Assistance (GA) Manual, Sections II, III, V, VI, VII, X, XI, XII and XIII

GA Rule #26P – P.L. 2024, Chapters 575 and 643

The proposed rule changes would update the Maine General Assistance (GA) Manual consistent with legislative changes to 22 M.R.S. §§ 4302, 4304 and 4305 made by P.L. 2024, Chapters 575 and 643.

General Assistance Emergency Rule #26 Adoption

EMERGENCY RULE - GENERAL ASSISTANCE (GA) Program

10-144 C.M.R. Ch. 323; MAINE GENERAL ASSISTANCE Manual; Section V

GA Rule #26E – P.L. 2024 Ch. 642

The Department adopts this emergency rule, which amends10-144 C.M.R. Ch. 323, Maine General Assistance (GA) Manual, Section V, MAXIMUMS, CATEGORIES AND LEVELS OF ASSISTANCE, to align with a legislative change to 22 M.R.S. § 4308(2) made by P.L. 2024 Ch. 643.

MaineCare Notice of Agency Rule-making Adoption, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

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.

Public Forum Postponed: Section 107, Psychiatric Residential Treatment Facilities (PRTFs) Revisions to Previously Proposed Draft Rates

The public forum to present revisions to the previously proposed draft rates and model for PRTF services that was scheduled for November 6, 2024, has been postponed. The Department will reschedule this forum and send notice of the new date and time. Please watch for a future notice. We appreciate your ongoing patience and apologize for any inconvenience.   

For questions, please contact Dwayne Parsons, MaineCare’s Manager of Rate Setting and Reform.     

2024 – 2025 Influenza Seasonal and Other Vaccines

All vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered by MaineCare pharmacy benefit without a member copayment, this includes influenza vaccines.

In preparation for the 2024-2025 Influenza (Flu) season, please review the MaineCare preferred vaccines listed below. These vaccines do not require Prior Authorization (PA). 

Influenza vaccines: 

Federally Qualified Health Center (FQHC) Providers – Notice of Award (NOA) Update

Effective November 1, 2024, MaineCare will only accept Health Resources and Services Administration (HRSA) Notice of Award (NOA) to update the license term date.

FQHC providers are required to update their license term date annually and provide their latest NOA. Previously, MaineCare also allowed the Federal Tort Claims Act (FTCA) document to count as the NOA but we will no longer accept them to update the license term date. Providers must update the license term date with the end date listed on the Budget Period within the NOA to avoid delays.

Verify a Code is Reimbursable for Special Population with Limited Benefits (SPLB)

If you see a member has SPLB MaineCare coverage when verifying eligibility on the Health PAS Online Portal, do not assume the coverage is hospital inpatient services only. There are several different SPLB coverage types and the services MaineCare reimburses for depends on which limited benefit coverage the member receives.  

Contact Gainwell Provider Services at 1-866-690-5585 to verify if the procedure code you intend to bill is covered.

Training Opportunity Available for Family and Caregivers of Adults Receiving Services Within Section 12, 19, and 96 Programs

The Office of Aging and Disability Services (OADS), in collaboration with the National Alliance on Mental Illness (NAMI) Maine, is excited to announce a virtual De-Escalation training opportunity scheduled for Tuesday, December 10, 2024, from 3:00 PM – 5:00 PM.

This training is available for caregivers providing care to Section 12, 19, and 96 members and the cost is free! Caregivers can include personal support staff, attendants, home health aides, nurses, or other natural and family supports.

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