• Read more about Children’s Single Assessment Referral Training for Behavioral Health Home (BHH) and Targeted Case Management (TCM) Care Coordinators

Referral Process

Beginning February 2, 2026, Single Assessment Referrals will be the required statewide process for determining eligibility for children’s medium- and high-intensity behavioral health services, under Maine’s Children’s Behavioral Health Services Settlement Agreement.

Single Assessment is a standardized approach to assessing behavioral health needs and identifying the appropriate level of care and clinically indicated services for children who require medium- to high-intensity services.

Training

• Read more about Medicare Standardization Rate Updates for Calendar Year 2026 (CY26)

Corrected for Calendar Year

Effective January 1, 2026, MaineCare will update reimbursement rates for Medicare covered codes and services for the sections of policy noted below. The new rates will reflect 72.4% of the most recent 2026 Medicare rates.

• Read more about Medicare Standardization Rate Updates for Calendar Year 2025 (CY25)

Effective January 1, 2026, MaineCare will update reimbursement rates for Medicare covered codes and services for the sections of policy noted below. The new rates will reflect 72.4% of the most recent 2026 Medicare rates.

• Read more about Section 4, Ambulatory Surgical Center (ASC): Annual Rate Adjustment

Effective January 1, 2026, MaineCare is updating ASC rates to reflect 100% of current year Medicare rates.

Once new rates are implemented, MaineCare will provide adjustment billing guidance and post an updated fee schedule to the Rate Setting webpage of the Health PAS Online Portal. 

• Read more about Section 5, Ambulance Services: January 1, 2026, Rate Update – CR 136854

Effective January 1, 2026, MaineCare will update ambulance service rates to reflect 100% of the most current Maine Medicare area 99 urban, rural, or super rural rates.

• Read more about Section 60, Durable Medical Equipment (DME) and Supplies: Annual Rate Adjustment

Effective January 1, 2026, MaineCare is updating DME rates to reflect 100% of current year Medicare rates.

Once new rates are implemented, MaineCare will provide adjustment billing guidance and post an updated fee schedule to the Rate Setting webpage of the Health PAS Online Portal. 

• Read more about Attention Section 60 and Section 109 Hearing Aid Providers: Binaural Hearing Billing and Prior Authorization (PA) Guidance Update

Effective November 15, 2025, MaineCare implemented a temporary process to support member access to hearing aids when a provider determines a member is clinically eligible for a binaural hearing aid, but the member only meets MaineCare Benefits Manual (MBM), Chapter II, Section 60: Durable Medical Equipment and Section 109: Speech and Hearing Services coverage criteria for a monaural hearin

• Read more about Updated Guidance: Provider Responsibility Regarding Third Party Liability and Secondary Billing

In a previous notice, the Office of MaineCare Services (OMS) reminded providers of their responsibility regarding third-party liability and secondary billing. Pursuant to MaineCare Benefits Manual (MBM) Ch. I Section 1.07-3(B), MaineCare is the payor of last resort.

• Read more about Elimination of Mailing Paper Remittance Advice (RA) and Reduction of Paper Checks, CR 132320

Paper RAs

Starting the week of December 22, 2025, the Office of MaineCare Services (OMS) will no longer mail paper RAs to providers. This is a cost-saving initiative for the Department. We encourage you to reference the electronic PDF versions of the RAs posted on the Health PAS Online Portal. Advantages of using the PDF version include easier member and claim searching and access to previous RAs.

• Read more about Disclosures of Organizational Change Reminder

If your organization is going through an organizational change, please contact Gainwell to receive guidance before beginning an enrollment/revalidation/re-enrollment application or maintenance case and prior to submitting the Disclosure of Organizational Change for MaineCare form. This allows Gainwell/MaineCare to review the change and decide what is the best way the provider needs to enroll or update their enrollment.

Please contact the MaineCare Enrollment email box with questions.