The individual designated by your organization to vote on MACSP business.
Please list the Mainecare Section # and service type for other IDD services agency provides.
Membership Dues
Please complete all applicable information requested regarding total revenue your organization or business receives for providing services to children and adults with intellectual disabilities, Autism and Brain Injuries in the State of Maine.
MACSP defines qualifying revenue as revenue generated by the agency from the provision of any of the services listed in the Mainecare Benefits Manual (MBM) Chapters 2 and 3 under Sections 13, 18, 19, 20, 21, 28, 29, 50, 97-Appendix F, and 102.
Include revenues from Section 13, 18, 19, 20, 21, 28, 29, 50 (ICF), 65, 97-F (PNMI), 102 and IDD revenue from any related entities.
Select the corresponding dues level for your agency. An invoice for this amount will be sent to the invoicing contact listed on this application, with a cc to the designated voting member for your organization.
Payment – Payment is due within 30 days of invoice receipt or no later than August 31, 2023.
Details will be provided in the invoice sent within seven business days of submitting this renewal form.