An Act to Expedite Provider Enrollment in MaineCare

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132nd MAINE LEGISLATURE
FIRST SPECIAL SESSION-2025
Legislative Document No. 1758
H.P. 1176 House of Representatives, April 22, 2025
An Act to Expedite Provider Enrollment in MaineCare
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative ARFORD of Brunswick.
Cosponsored by Senator TALBOT ROSS of Cumberland and
Representatives: BELL of Yarmouth, DAIGLE of Fort Kent, GRAHAM of North Yarmouth,
JAVNER of Chester, SHAGOURY of Hallowell, ZAGER of Portland, Senators: BALDACCI
of Penobscot, MOORE of Washington.

Page 1 - 132LR0823(01)
1Be it enacted by the People of the State of Maine as follows:
2Sec. 1. 22 MRSA §3173-L is enacted to read:
3§3173-L. Provider enrollment; expedited provisional approval
4 The process for expedited provisional approval of provider enrollment in the
5 MaineCare program is governed by the following provisions.
61. Definitions. For the purposes of this section, unless the context otherwise indicates,
7 the following terms have the following meanings.
8 A. "National provider identifier" means a unique, 10-digit, intelligence-free,
9 identification number issued by the federal Centers for Medicare and Medicaid
10 Services to a provider of medical or health services and any other person or
11 organization that furnishes, bills or is paid for health care in the normal course of
12 business. "Intelligence-free" means that the numbers do not carry other information
13 about a healthcare provider such as the state in which the provider lives or operates or
14 the provider's medical specialty.
15 B. "Provider" means an individual, a facility or an organization that provides services
16 under the MaineCare program.
172. Expedited provisional approval. The department shall provisionally approve the
18 enrollment application of a provider in good standing, as defined by rule pursuant to
19 subsection 6, paragraph C, subparagraph (1), that has a national provider identifier within
20 48 hours of receipt of a complete application if the provider is employed by a health care
21 entity that has an enrollment application approval rate of greater than 90% in the previous
22 5 years.
233. Authority to review; final approval. The department may conduct a complete
24 review of an applicant granted expedited provisional approval pursuant to this section. For
25 a provider that has received expedited provisional approval pursuant to subsection 2, the
26 provider's enrollment is considered finally approved 60 days following the receipt of the
27 provider's application for expedited provisional approval unless the department
28 affirmatively revoked the provisional approval during the 60-day period.
294. Approval suspended or revoked. Nothing in this section may prevent the
30 department from suspending or revoking the approval of an applicant that has been granted
31 expedited provisional approval following complete review if a material deficiency is
32 determined to exist. If the provider's approval is revoked, the provider is not eligible for
33 expedited provisional approval under subsection 2 and must go through the regular
34 enrollment process as provided by rule to regain enrollment.
355. Approval revoked; reimbursements for payments during period of provisional
36approval. The Office of MaineCare Services may seek reimbursement for any payments
37 made by the MaineCare program for services provided by a provider if its expedited
38 provisional approval was revoked in the 60-day expedited provisional approval period
39 pursuant to subsection 3.
406. Rulemaking. The department shall adopt rules to implement this section. The rules
41 must, at a minimum:
Page 2 - 132LR0823(01)
1 A. Prescribe a method to determine the enrollment application approval rate of the
2 provider's employer under subsection 2;
3 B. Develop a process for suspending an individual provider's expedited provisional
4 approval status; and
5 C. Define the following:
6 (1) The elements of "good standing," under subsection 2; and
7 (2) "Material deficiency" under subsection 4.
8 Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5,
9 chapter 375, subchapter 2-A.
10SUMMARY
11 This bill establishes an expedited process for providers to enroll in the MaineCare
12 program. Under the bill, the Department of Health and Human Services must provisionally
13 approve the enrollment application of a provider in good standing that has a national
14 provider identifier within 48 hours of receipt of a complete application if the provider is
15 employed by a health care entity that has an enrollment application approval rate of greater
16 than 90% in the previous 5 years. The department may conduct a complete review during
17 a 60-day expedited provisional approval period, but the provider is considered approved
18 after 60 days if the department does not affirmatively deny approval during that period.
19 However, the bill does not prevent the department from suspending or revoking approval
20 after the 60-day period if a material deficiency exists. If the provider's approval is revoked,
21 the provider is not eligible for expedited reenrollment but must go through the regular
22 enrollment process as established by rule. The Office of MaineCare Services may seek
23 reimbursements for any payment made to a provider during the provisional period if the
24 provider's provisional approval is revoked. The department must adopt rules to implement
25 these provisions.
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