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MaineCare is extending the deadline for comments on the Nursing Facility draft rate methodologies, from April 8, 2024, to April 15, 2024. The Department has provided additional clarifying information about the rate model and wishes to give interested parties time to consider the information.
The Centers for Medicare & Medicaid Services (CMS) has revised its rates effective March 9, 2024. To align with these changes, MaineCare has been working to update reimbursement rates for Medicare covered codes and services. The new rates will reflect 72.4% of the most recent, 2024 Medicare rates.
Rates were implemented on April 3, 2024, for all sections noted below.
Please express interest by April 19, 2024
Introduction:
Person-reported outcomes (PROs) are an important way for organizations, providers, and facilities to assess their success in meeting the person-centered needs of patients and residents under their care. While some nursing home facilities are collecting CoreQ data as one of their quality measures, most residential care facilities are not.
On March 18, the Division of Licensing and Certification (DLC) sent notice that Section 28 providers are required to obtain a mental health license in order to provide Section 28 services due to the recently adopted CMR 10-144 Chapter 123, Behavioral Health Organizations Licensing Rule. The notice included an application filing deadline of May 11, 2024, for providers who are not currently licensed as mental health agencies.
The Centers for Medicare & Medicaid Services (CMS) has revised its rates effective March 9, 2024. To align with these changes, the Department is in the process of updating reimbursement rates for Medicare covered codes and services for the sections noted below. The new rates will reflect 72.4% of the most recent, 2024 Medicare rates.
With the new Evergreen system rollout, previous authorizations with a prefix of “EIS” have been replaced by new authorizations with a prefix of “LTS.”
Our current Electronic Data Interchange (EDI) 837 file was developed with a max of 15 characters for authorization IDs. Some LTS authorization IDs were generated with a max of 17 characters. When submitting 837 claims, providers are reporting that the last two characters of the 17-character authorization ID are getting cut off, resulting in denied claims with the “UM not found” edit.
The Office of MaineCare Services thanks pharmacy providers for transmitting claims with dates of service during the outage period (February 21 through March 26).
The MaineCare Service Disruption Office Hours with MaineCare Pharmacy Benefit scheduled for Friday, April 05, 2024, has been rescheduled to Tuesday, April 09, 2024.
On March 27, 2024, MaineCare held a virtual public meeting with interested stakeholders to present the Palliative Care Team (PCT) Services Draft Model and provide an overview of a Staffing Survey for current palliative care providers. Stakeholders were able to ask questions and participate in an open discussion.
By order of Governor Mills State Offices will be closed Thursday, April 4, 2024 due to severe weather conditions. The MaineCare Service Disruption Office Hours with MaineCare Pharmacy Benefit scheduled for this day has been rescheduled.