State-Funded Abortion Services Update 

State-Funded Abortion Services Update 

Previously, you were notified that MaineCare has begun covering abortion services that are not eligible for reimbursement from the Centers for Medicare and Medicaid Service (CMS). This rule went into effect on September 19, 2019. As we work to implement all required systems changes, the process in which you receive payment will be different during this initial implementation period.  When you submit a claim to MaineCare for state-funded abortions, you will receive a payment through the usual remittance process, but the payment amount will only appear on the summary page of the Remittance Advice (RA) and will be reflected as “Other.”  The details of that payment will not appear in the body of the RA. Once all systems changes are completed, these payments for state-funded abortions will go through the normal process and appear in the body of your RA along with other regular claims that may have processed for that week.  

To Summarize: 

• Initial implementation period: State-funded abortion service payments will be handled manually with a reimbursement amount noted on the summary page of your weekly RA. 

• After all system changes are implemented: State-funded abortion service payments will follow the normal RA process. 

1. Detailed information for payments processed prior to the system change will appear in the body of the RA and will reference zero dollar payment(s), to reflect reimbursement you have already received for this service. This will only apply to those payments that you received prior to the implementation of the system change. 

2. Detailed information for payments processed after the system change will appear as usual.  Detailed information of the payments will appear in the body of the RA.

Also, as a reminder, state-funded abortion services are not MaineCare-covered services, which prohibits the use of Non-Emergency Transportation (NET) to and from these services. NET is only available to provide transportation for MaineCare members going to or coming from MaineCare-covered services. To learn more about state-funded abortions, please see our September 19, 2019 message which outlines the requirements and billing process.