№ files_lp_3_process_7_041742
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Administrative regulatory manual establishing the statutory basis, governance structure, and operational rules for the MaineCare program, including provider enrollment, member eligibility, covered services, reimbursement procedures, compliance measures, and appeals processes.
Jurisdiction:
State of Maine, United States
Program:
MaineCare
Governing Law:
Title XVIII, XIX, and XXI of the Social Security Act; 42 U.S.C.A. §§1395 et seq.; 42 U.S.C.A. §§1396 et seq.; 42 U.S.C. §1397; 22 M.R.S. §§10, 12, 42(1), 3173 et seq.; 22 M.R.S. §1901 et seq.; 22 M.R.S. §3174-T
Administering Authority:
Maine Department of Health and Human Services
Federal Oversight:
Centers for Medicare and Medicaid Services (CMS)
Document Type:
Benefits manual / administrative regulations
Subject:
Administration, provider participation, member eligibility, covered services, reimbursement, compliance, appeals, and program integrity
Related Programs:
Medicare; Medicaid; State Children’s Health Insurance Program (CHIP); Cub Care Program
Responsible Units:
Office for Family Independence; Program Integrity Unit; Division of Audit; Office of MaineCare Services
Scope:
Statewide administration of MaineCare benefits and services
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Year:
2025
Region / City:
Maine
Theme:
Healthcare, Medicaid
Document Type:
Manual
Institution:
Department of Health and Human Services, Office for Family Independence
Author:
State of Maine
Target Audience:
General public, healthcare professionals, individuals seeking MaineCare benefits
Period of Validity:
Until April 29, 2025
Approval Date:
April 29, 2025
Date of Changes:
Not specified
Year:
2025
Region / City:
Maine
Topic:
Healthcare Eligibility
Document Type:
Manual
Organization:
Department of Health and Human Services, Office for Family Independence
Author:
Unknown
Target Audience:
State officials, healthcare providers, and applicants for MaineCare
Period of Validity:
Effective April 29, 2025
Approval Date:
Not specified
Date of Last Update:
April 29, 2025
Contextual Description:
A policy manual providing eligibility criteria and administrative processes for MaineCare, including coverage groups, benefits, and eligibility verification methods.
Year:
2023
Region / City:
Maine
Subject:
Home Health Care Services
Document Type:
Regulations
Agency:
MaineCare
Author:
Maine Department of Health and Human Services
Target Audience:
Healthcare providers, home health agencies, certified home health aides, and healthcare professionals involved in home care services
Effective Period:
Ongoing
Approval Date:
N/A
Date of Amendments:
N/A
Year:
N/A
Region / City:
Maine
Topic:
Medicaid Administration
Document Type:
Policy Manual
Organization / Institution:
Maine Department of Health and Human Services
Author:
N/A
Target Audience:
Health Providers, MaineCare Participants
Validity Period:
N/A
Approval Date:
N/A
Modification Date:
N/A
Note:
Year
Subject:
Speech and Hearing Services
Document Type:
Policy
Organization:
MaineCare
Target Audience:
Healthcare Providers, Speech and Hearing Professionals
Context Description:
Policy detailing specific billing codes and modifiers for speech and hearing services covered under MaineCare, including professional rates for various diagnostic and treatment procedures.
Year:
2023
Region / City:
Maine
Theme:
Health care services
Document type:
Policy
Agency:
MaineCare
Author:
Maine Department of Health and Human Services
Target audience:
MaineCare providers and beneficiaries
Period of validity:
Ongoing
Approval date:
N/A
Amendment date:
N/A
Year:
2022
Region / City:
Maine
Theme:
Healthcare Services for Children and Adolescents
Document Type:
Guidelines
Organization:
MaineCare
Author:
Maine Department of Health and Human Services
Target Audience:
Healthcare Providers, MaineCare Members, and Their Caregivers
Effective Period:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2015
Region / City:
Maine
Topic:
Non-Emergency Transportation
Document Type:
Policy and Procedure
Organization / Institution:
Maine Department of Health and Human Services
Author:
MaineCare Services
Target Audience:
MaineCare Members, Transportation Providers, Brokers
Effective Period:
From 4/5/2015
Approval Date:
4/5/2015
Date of Last Update:
4/5/2015
Effective Date:
11/18/14
Program:
MaineCare
Jurisdiction:
Maine
Country:
United States
Issuing Authority:
Department of Health and Human Services
Regulatory References:
45 C.F.R. §162.1000; 45 C.F.R. §1011; 42 C.F.R. §447.205
Related Agency:
Centers for Medicare and Medicaid Services (CMS)
Document Type:
Reimbursement rate schedule and billing code list
Subject:
Family planning services and related medical procedures
Code System:
Healthcare Common Procedure Coding System (HCPCS)
Update Frequency:
Approximately quarterly updates issued by CMS
Provider Requirements:
Use of FP modifier for applicable services; CLIA-waiver certificate required for certain laboratory codes
Reimbursement Basis:
Fee-for-service rates
State Plan Requirement:
Payment subject to approval of a state plan amendment by CMS
Publication Method:
Notices of reimbursement methodology change and revised billing instructions
Web Reference:
www.maine.gov/dhhs/audit/rate-setting/index.shtml
Year:
2012
Region / City:
Maine
Topic:
Occupational Therapy Services
Document Type:
Policy document
Organization:
MaineCare
Author:
MaineCare
Target Audience:
Healthcare providers and occupational therapists
Period of Validity:
Ongoing
Approval Date:
06/29/12
Modification Date:
None
Year:
2026
Region:
Maine, USA
Topic:
Healthcare Payment and Delivery Model
Document Type:
Policy and Program Manual
Organization:
Maine Department of Health and Human Services
Author:
MaineCare Program Administration
Target Audience:
Primary Care Providers and MaineCare Members
Participation:
Voluntary for both providers and members
Payment Model:
Population-Based Payments with Performance-Based Adjustments
Implementation Period:
Ongoing
Certification Reference:
CEHRT under 42 CFR §414.1305
Legal Authority:
Social Security Act Section 1905(t)(1)
Scope:
Primary care, behavioral health integration, care plans, and community health workers
Operational Structure:
Accountable Communities, Joint Care Management, Community Care Teams
Risk Assessment:
Member attribution, risk scores, and performance measures
Reimbursement Mechanism:
Tiered PBPs and quarterly PBAs
Year:
2026
Region / City:
Zambia
Topic:
Insurance, Procurement, Health Organization
Document Type:
Request for Proposal (RFP)
Organization / Institution:
Amref Health Africa
Author:
Amref Health Africa
Target Audience:
Insurance companies, brokers
Period of Validity:
1 January 2026 to 31 December 2026
Approval Date:
Not specified
Date of Changes:
Not specified
Context:
A formal request for proposals for insurance and equipment coverage for Amref Health Africa’s Zambia operations, detailing technical specifications and requirements for various insurance services.
Year:
2023
Region / city:
Singapore
Topic:
Pharmaceutical manufacturing and regulatory requirements
Document type:
Regulatory guideline
Organization:
Health Sciences Authority
Author:
Health Sciences Authority
Target audience:
Pharmaceutical manufacturers, regulatory professionals
Validity period:
N/A
Approval date:
N/A
Amendment date:
N/A
Year:
2026
Region / City:
Singapore
Subject:
Pharmaceutical Manufacturing and Regulatory Compliance
Document Type:
Regulatory Guidelines
Organization:
Health Sciences Authority (HSA)
Author:
Health Sciences Authority
Target Audience:
Pharmaceutical Manufacturers, Regulatory Affairs Professionals
Period of Validity:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2024
Region / City:
United States
Theme:
Facility Assessment, Healthcare, Staffing, Compliance
Document Type:
Toolkit
Agency / Organization:
Centers for Medicare & Medicaid Services
Author:
Not specified
Target Audience:
Healthcare facility leaders and administrators
Period of Validity:
2024
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2023
Region / City:
North Dakota
Theme:
Early Childhood Services, Staff Handbook
Document Type:
Handbook
Organization / Institution:
ND Early Childhood Services
Author:
ND Early Childhood Services
Target Audience:
Child Care Program Staff
Period of Action:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
Not specified
Region / City:
Not specified
Subject:
Procurement and Contracting Requirements
Document Type:
Table of Contents
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Not specified
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
Not specified
Region / City:
Not specified
Topic:
First aid kit contents for various workplace scenarios
Document type:
Checklist
Organization:
Department of Education and Training
Author:
Not specified
Target audience:
Workplace managers, OHS nominees, Health and Safety Representatives, employees
Period of validity:
Not specified
Approval date:
Not specified
Date of amendments:
Not specified
Year:
2023
Region / city:
Not specified
Subject area:
Social Welfare, Social Work, Human Rights
Document type:
Course syllabus
Organization / institution:
Not specified
Author:
Not specified
Target audience:
Students
Validity period:
Not specified
Approval date:
Not specified
Modification date:
Not specified
Note:
Year