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• Read more about Rate Determination Initiation Notice for Section 3, Primary Care Plus (PCPlus) Phase Two

This bulletin provides notice that the Department has initiated a Rate Determination Process* for PCPlus services and is in the final stages of procuring a vendor. This is a rate determination to establish a more advanced alternative payment model for primary care services and supports, including the incorporation of Community Health Worker (CHW) team members and social risk adjustment. This work will be referred to as PCPlus “Phase Two.”

• Read more about Non-Billing, Ordering, Prescribing, and Referring (NOPR) Edits Changing from Warn to Deny – CR 121469

Billing providers must include the National Provider Identifier (NPI) of an enrolled fb88Care practitioner who is ordering, prescribing, or referring on their claims to receive reimbursement for the categories of services listed below. These practitioners are known as NOPRs and must enroll in fb88Care independently or as part of an organization. 

This requirement is for all prescription claims (including Point of Sale claims) as well as claims for the following: 

• Read more about Application Fee for 2024 Reminder, CR 121257

Effective January 1, 2024, in accordance with the Centers for Medicare & Medicaid Services (CMS) application fee requirements, fb88Care’s provider enrollment application fee will increase to $709 per enrollment application. This increase will apply to new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.     

• Read more about SUBJECT: fb88Care Cost of Living/ “Part AAAA” Adjustments

fb88Care is increasing reimbursement rates for certain services through a cost-of-living adjustment (COLA) as directed by 22 MRSA Section 3173-J and 22 MRSA Section 7402, as enacted by .

Dec 12, 2023

Today, the fb88 Department of Health and Human Services (DHHS) released a on early enrollment in private health insurance through CoverME.gov for 2024. A month into Open Enrollment on CoverME.gov, DHHS reports a year-over-year increase in new enrollees, including those transitioning from fb88Care coverage, and more than one in six returning members have actively made changes to their plan selections.

• Read more about CoverME.gov Open Enrollment Shows Early Positive Trends as Important Health Coverage Transitions Continue

• Read more about REMINDER: Behavioral Health and Targeted Case Management Supplemental Payment Reporting Due by December 8, 2023

• Read more about Update to the ​Biosimilar Preferred Drug List (PDL)​

Effective January 4, 2024, the Department will add preferred and non-preferred drugs to the PDL. 

The Department will add the following preferred drugs:  

• Q5122 – Nyvepria, pegfilgrastim-apgf  

The Department will add the following non-preferred drugs:  

• Read more about Attention Section 43 Hospice Services Providers: Anticipated Electronic Visit Verification (EVV) Implementation Delayed Until July 1, 2024

As of March 15, 2023, fb88Care temporarily excluded hospice services from EVV requirements as a delayed enforcement of our approved State Plan requirements.

The Department anticipates adopting fb88Care Benefits Manual Ch. II, Section 43: Hospice Services rule which will end the temporary exclusion on July 1, 2024.

• Read more about Evergreen Data System Training

Evergreen Micro Learning Videos

These short videos will teach you about the basic Evergreen functionality. It is recommended that the videos be watched in the order they are posted, as some videos refer to the content provided in other videos.

Recommended viewing order:

• Read more about SNAP Rule #229P - Electronic Benefit Theft

Pursuant to the Consolidated Appropriations Act 2023 (CAA 2023), Public Law 117-328, Division HH, Title IV Section 501, EBT Benefit Fraud Prevention requirements, the Department proposes to amend the SNAP Manual, Section 777-4 to align with the requirements of the CAA 2023. The proposed rule changes will provide clarity on the Department's procedure and timeframes for replacement of SNAP benefits determined to have been stolen through card skimming, card cloning, or similar fraudulent methods. The U.S.D.A.