• Read more about Pilot Program for Transitional Services

This rule change is proposed to repeal a pilot program that was established in 1988 to provide transitional services for adults aged 20-26 that were clients of the Office of Aging and Disability Services, formerly the Office of Adults with Cognitive and Physical Disabilities. The program offered a method of funding that was otherwise unavailable or not reimbursable under existing funding systems and has not been operational for several years as redundant and similar services have since been adopted and implemented federally and statewide to support the target population.

• Read more about Electronic Visit Verification (EVV) Phase 2 Trainings

The EVV requirements for Home Health providers delivering services under Section 40 were implemented on January 1, 2023.

We continue to offer weekly provider and aggregator trainings. All trainings are online via Microsoft Teams.

NOTE:  The Absorb training system has been updated to allow providers to register for trainings more than once.

EVV Training Schedule

• Read more about Revalidate with MaineCare to Avoid Claim Denials

The Affordable Care Act (ACA), Section 6401, states that almost all provider types must revalidate their information with MaineCare every five years. Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidations began in January 2022.  

• Read more about ​​COVID-19 Vaccine Updates for Fall 2023​

MaineCare will continue to provide full coverage, without cost sharing through September 30, 2024, for the COVID-19 vaccine and its administration as required by the American Rescue Plan Act (ARPA) of 2021. The ARPA requirement applies only to those persons with current MaineCare coverage.

• Read more about ​Non-Emergent, Emergency Department (ED) Pricing Failure, TR 113880

MaineCare identified an overpayment of some emergency room hospital claims. These claims received the Ambulatory Payment Classifications (APC) rate vs. the non-emergent rate. The affected date range is July 01, 2021, through March 31, 2023. MaineCare will reprocess all affected claims and no provider action is needed. 

• Read more about ​UPDATED Billing Guidance and Claims Reimbursement for Distinct Psychiatric and Substance Use Disorder (SUD) Units

On September 19, 2023, the Office of MaineCare Services (OMS) sent a notice advising hospitals with distinct psychiatric and SUD units that our systems will update to reimburse claims to such units on October 1, 2023, as described in the

• Read more about New Hyaluronic Acid Derivatives Criteria Sheet, CR 119147

MaineCare replaced the Prior Authorization (PA) Synvisc Hyalgan Euflexxa Orthovisc form.  

• Read more about Chapter 101, MaineCare Benefits Manual

Notice of MaineCare Reimbursement Methodology Change

AGENCY: Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual

• Read more about MaineCare Member E-Messages

• Read more about 10-144 C.M.R. Ch. 301 Supplemental Nutrition Assistance Program (SNAP) Manual; Section 999-2

Federal Supplemental Nutrition Assistance Program (SNAP) regulations provide that certain able-bodied adults without dependents (ABAWDs) are subject to a maximum of three months of benefits over a 36-month period, unless they work 20 hours or more per week (averaged monthly) or participate in and comply with requirements of a work program.  Individuals who reside in certain geograp