Our Goal
To provide a clear and transparent process for MaineCare rate determinations, with opportunities for robust participation from all interested stakeholders.
Get more information on how you can participate and to view our monthly Rate System Reform updates.
We continue to update this page with important dates and progress made on past, current, and future rate determination work. Please check in often, as this site is a work in progress.
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What is Rate Determination?
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Rate Determination is a process conducted by the department to establish the reimbursement rate methodology, base rate amount or payment model for a MaineCare section of policy or for a specific covered service. Rate Determination is done through adoption or adaptation of a benchmark rate or methodology from another payer (e.g., private insurance, Medicare, another Medicaid agency) or developed through a rate study. Determinations may also lead to a rate study.
There are five phases in a Rate Determination:
Phase 1 Project Kickoff
Phase 2 Provider Data Collection
Phase 3 Rate Model Development
Phase 4 Public Comment
Phase 5 Finalize Proposed Rates
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CY 2024 Rate Determinations - in Progress
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Public Notices
Presented Materials and Other Documents
Other Information
65 Mobile Crisis Response Teams Initiation 9/01/2022
Kickoff and survey overview 3/11/2022
Draft Service Model and Survey Invite 2/21/2023
Kickoff recording - 5/12/2022
Draft Service Model Presentation (PDF) 2/24/2023
Draft Service Model and Survey Tool Recording - 2/24/2023
Draft Service Model and Rates, Public Forum HMA-Burns Presentation, DHHS Presentation, Draft Rate Models and Recording
Rationale: The American Rescue Plan Act of 2021 (ARP) amended Title XIX of the Social Security Act by adding after section 1946 (42 U.S.C. 1396w–5) the following new section: SEC. 1947. "State Option to Provide Qualifying Community-Based Mobile Crisis Intervention Services.” DHHS is reforming mobile crisis services to improve the service and align with this new federal opportunity.
Services: Mobile Crisis/Resolution
Effective Date: Pending Service Redesign
Next Rate Adjustment: Pending Service Redesign
Further Section Change Needed: None
107 Psychiatric Residential Treatment Facility Draft Rate Model Public Review and Comment 5/26/2023
Public Forum Presented Materials and Comment Deadline - 6/16/2023
(Please see CORRECTION to the above notice)
Revised Draft Rates Public Review and Comment Invite - 10/22/2024
Draft Rate/Public Forum Presentation Recording - 6/15/2023
Draft Rate/Public Forum Presentation (PDF) - 6/15/2023
Rationale: P.L. 2021, Ch. 635
Services: All
Effective Date: Pending Rate Determination
Next Rate Adjustment: Pending Rate Determination
Further Section Change Needed: None
45, Specific to Acute Inpatient Distinct Psychiatric & SUD Units (for medically supervised withdrawal) Initiation 10/7/2022
Hospital Informational Forum 12/5/2022
Public Forum Presented Materials and Comment Deadline 1/26/2023
Rate Determination Update 6/16/2023
Final Draft Rates Notice - 7/14/2023
Hospital Informational Forum Presentation (PDF) 12/19/2022
Hospital Informational Forum Recording 12/19/2022
Draft Public Forum Presentation (PDF) - 1/12/2023
Draft Rate Determination Forum Recording - 1/12/2023
Comment Summary with Department Response (PDF) - 5/8/2024
Final Rates & Methodology (PDF) - 5/8/2024
Rationale: P.L. 2021, Ch. 635
Services: Inpatient Distinct Psychiatric and Substance Use Disorder Units
Effective Date: July 1, 2023
Next Rate Adjustment: COLA Annually in July
Further Section Change Needed: None
46, Institutions for Mental Disease (IMD) Initiation 10/7/2022
Rationale: P.L. 2021, Ch. 635
Services: All
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: TBD
45 Hospitals Initiation 6/23/2023
Draft Rate Model Public Forum Invite 11/29/2023
Draft Reimbursement Methods Public Forum Invite - 2/12/2024
Draft Rates & Methodologies Public Review and Comment Invite - 3/22/2024
Public Review Rescheduled - 4/2/2024
Public Review Postponed - 5/1/2024
Public Review Rescheduled - 5/31/2024
Public Forum Presented Materials & Comment Deadline - 6/13/2024
Draft Rate Methodology Public Review: Inpatient Presentation (PDF) and Recording - 12/11/2023
Draft Reimbursement Methodology Public Review: Outpatient Presentation (PDF) and Recording - 2/26/2024
Public Review and Comment: Forum Recording and PPT Presentation (PDF) - June 11, 2024
Clarifications from June 11, 2024, Public Review and Comment Forum (PDF) - 6/18/2024
Updates Following June 11, 2024, Forum (PDF) - 7/25/2024
Rationale: Public Commitment. Outdated reimbursement methodology, incent quality/cost effectiveness
Services: All
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: TBD
30 Family Planning (New Alternative Payment Model) Initiation 11/17/2022
Kickoff 1/26/2023
Public Forum 10/20/2023
Presented Materials and Comment Deadline 11/28/2023
Kickoff Meeting Presentation (PDF) - 1/26/2023
Kickoff Meeting Recording - 1/26/2023
APM Draft Rate & Service Model Public Review & Comment Version 2 (PDF) & (Corrected) Version 3 (PDF) & Recording - 11/20/2023
Rationale: Public Commitment. Current reimbursement does not reflect team-based, patient centered approach to integrated care
Services: All
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: None
67, 97 C - Nursing Homes and Private Non-Medical Institutions - Appendix C Residential Care Initiation 1/12/2023
Kickoff 2/1/2023
Provider Rate Method Workgroup #1 Presented Materials Notice 3/28/2023
Provider Rate Method Workgroup #2 Presented Materials Notice 4/24/2023
Provider Rate Method Workgroup #3 Presented Materials Notice - 5/22/2023
Provider Rate Method Workgroup #4 Presented Materials Notice - 6/9/2023
Provider Rate Method Workgroup #5 Presented Materials Notice - 6/30/2023
Draft Rate Methodology Public Review and Comment for NF's - 2/23/2024
Comment Deadline Extended - 3/25/2024
Comment Deadline Extended - 4/17/2024
Revised Draft Rates and Methodologies Invite - 10/9/2024
Revised Draft Rates and Methodologies Comment Deadline & Presented Materials Notice - 10/24/2024
Kickoff Meeting Presentation (PDF) and Recording - 2/1/2023
Interested Parties Rates Workgroup Meetings:
- Rates Workgroup Meeting #1 Introduction & Rate Discussion Presentation (PDF) and Recording – 3/13/2023
- Rates Workgroup Meeting #2 Direct/Indirect & Capital Costs Presentation (PDF) and Recording - 4/12/2023
- Rates Workgroup Meeting #3 Trend Discussion Presentation (PDF) and Recording - 5/17/2023
- Rates Workgroup Meeting #4 Risk Adjustment Discussion Presentation (PDF) and Recording - 6/5/2023
- Rates Workgroup Meeting #5 VBP and APM Discussion Presentation (PDF) and Recording - 6/26/2023
Draft Rate Methodology Public Review and Comment for Section 67, Nursing Facilities Part I, Presentation and Recording - 3/7/2024
Draft Rate Methodology Public Review & Comment for Section 67 Nursing Facilities Part II, Presentation and Recording - 3/8/2024
Questions & Answers on Draft Rate Model - 4/5/2024
Comments & Department Responses Following March 2024 Forums (PDF) - 10/30/2024
Revised Draft Rate Methodology (PPT) - 10/23/2024
Rationale: Public Commitment. Cost settlement system is administratively burdensome and does not incent quality of care or reward cost effectiveness.
Services: All
Effective Date: TBD, pending rate determination
Next Rate Adjustment:
- COLA. Annually in July
- Pending Rate Determination
Further Section Change Needed: None
97 - Appendix D Private Non-Medical Institution (Specific to Children’s Therapeutic Foster Care) Initiation - 6/9/2023
Draft Rate Model, Public Comment - 11/17/2023
Draft Rate Model Presented Materials & Comment Deadline - 12/8/2023
Comment Deadline Extended - 12/22/2023
Final Draft Rates and Comment Summary with Department Response - 10/21/2024
Draft Rate Model Public Review & Comment (PPT) and Recording - 12/6/2023
Comment Summary (PDF) and Final Draft Rates
Rationale: Address U.S. Dept. of Justice June 2022 findings that state there is a lack of support for foster parents and address barriers to access children’s behavioral health needs in the community and be less reliant on residential facilities/institutions
Services: Therapeutic Foster Care
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: TBD, pending rate determination
Demonstration - Certified Community Behavioral Health Clinics (CCBHC) Initiation - 6/20/2023
Kickoff - 9/11/2023
Prospective Payment System Cost Report Training Session Presented Materials - 11/6/2023
Deadline for Cost Report Submissions Extended to December 15, 2023 - 11/17/2023
CCBHC Certification Documentation Due September 6, 2024 - 8/16/2024
Public Review and Comment Invite - 10/15/2024
Kickoff Meeting Recording - 9/25/2023
Kickoff Meeting Presentation (PDF) - 9/25/2023
Prospective Payment System Cost Report Training Session: Recording and Presentation (PDF)- 10/31/23
Rationale: Department goal to increase access to high-quality, comprehensive behavioral health services
Services: Behavioral Health
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: TBD, pending rate determination
18, 20, 21, 29, HCBS for Individuals with Intellectual & Developmental Disabilities or Autism & Proposed Lifespan Waiver Initiation and Kickoff Notice - 9/8/2023
Amendment to Inititation and Kickoff Presented Materials Notice - 9/26/2023
Cost Survey Tool 12/15/2023
Deadline Extended: Cost Survey Tool - 12/26/2023
Kickoff Meeting Presentation (PDF) - 9/15/2023
Kickoff Meeting Recording - 9/15/2023
Rationale: P.L. 2023, Ch.412, Part LLLLL. Authorizes the new Lifespan program and directs the Department to facilitate federal approval of the new program and adopt rules implementing it. Because many Lifespan services will be similar to current Section 21 and Section 29 services, development of Lifespan rates requires existing Sections 18, 20, 21 and 29 rates to be reviewed.
Services: Lifespan, HCBS and Support services for Members with Intellectual Disabilities or Autism Spectrum Disorder
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: TBD, pending rate determination
TBD - Palliative Care Initiation - 10/13/2023
Kickoff - 3/11/2024
Kickoff Meeting Presentation and Recording - 3/27/2024
Rationale: LD/BI (LD 1064, 9817 HCBS plan)
Services: New Section/Service
Effective Date: TBD
Next Rate Adjustment: TBD, pending rate determination
Further Section Change Needed: TBD, pending rate determination
25 - Dental (Benchmark Assessment) Initiation - 10/13/2023
Kickoff - 10/26/2023
Benchmark Results and Draft Rates: Public Review & Comment - 3/14/2024
Public Review Rescheduled - 3/26/2024
Public Review Presented Materials and Comment Deadline - 4/16/2024
Comment Deadline Extended - 4/23/2024
Benchmark Assessment Results and Comment Summary - 7/19/2024
Kickoff Presentation (PDF) and Recording - 11/29/2023
Benchmarking Results and Draft Rates, Forum Recording and Presentation (PPT) - 4/12/2024
Comment Summary (PDF) - July 9, 2024
Rationale: Public Law Ch.639 requirement for services benchmarked to alternate payor source, update rates to most current year every 2 years
Services: All
Effective Date: 7/1/2024
Next Rate Adjustment: 7/1/2024 (Assessment of Benchmarks). COLA, Biennially in July
Ch. VI, Section 3 Primary Care Plus (PCPlus) Initiation - 12/4/2023 Rationale: 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
Services: All
Effective Date: TBD
Next Rate Adjustment: TBD, Pending Rate Determination
93 - Opioid Health Home, Includes New Model for Other SUDs Initiation - 11/8/2023
Kickoff Meeting Invite - 4/23/2024
Kickoff Presentation (PDF) and Recording - 5/7/2024
Rationale: P.L. 2021, Ch. 635, Part JJJ
Services: All
Effective Date: TBD
Next Rate Adjustment: TBD, Pending Rate Determination
TBD - Community Paramedicine (New Service) Initiation - 11/8/2023
Rationale: MaineCare coverage for community paramedicine services to improve health outcomes, improve access to care, and reduce unavoidable costs, especially for rural residents
Services: New Service (tentatively planned to be incorporated into Section 5 of the MaineCare Benefits Manual)
Effective Date: TBD
Next Rate Adjustment: TBD, Pending Rate Determination
14, 30, 31, 45, 90, 103, Certain Medicare Covered Family Planning Services & Long-Acting Reversible Contraception (LARCs) Initiation - 5/28/2024
Draft Rates Public Review & Comment Invite - 9/16/2024
Draft Rate Public Review and Comment Presented Materials and Comment Deadline - 9/30/2024
Draft Rates Public Review & Comment Presentation (PDF) and Recording -9/30/2024 Rationale: The Department is conducting this rate determination to maintain member access to Family Planning Services.
Services: Certain Medicare Covered Family Planning Services and Long-Acting Reversible Contraception (LARCs)
Effective Date: TBD
Next Rate Adjustment: TBD
12, 18, 19, 20, 21, 29, 40, 96, and 102, Home & Community Based Services (HCBS) Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology and Personal Support Services Initiation - 6/4/2024
Amendment to Initiation Notice - 8/8/2024
Kickoff Meeting Invite - 8/5/2024
Kickoff Presented Materials Notice with Registration Links to Upcoming Engagement Sessions - 8/30/2024
Engagement Sessions Presented Materials Notices:
- Assistive Technology
- Care Coordination
- Clinical Nursing
- Clinical Therapy
- Supportive Skills Building
- Therapeutic Intervention
- Personal Support
- Rehabilitative
Engagement Sessions, Questions & Answers Notice - 9/30/2024
Survey Notice - 10/22/2024
Code and Service Category List (PDF)
Kickoff Meeting Recording and Presentation (PDF) - 8/28/2024
Interested Parties Engagement Series:
- Assistive Technology Devices & Services: September 4, 2024, 11AM - 12PM EST Recording and Presentation (PDF)
- Care Coordination: September 6, 2024, 9AM - 10AM EST Recording and Presentation (PDF)
- Clinical Nursing Services: September 11, 2024, 11AM - 12PM EST Recording and Presentation (PDF)
- Clinical Therapy Services: September 13, 2024, 9:30AM - 10:30AM EST Recording and Presentation (PDF)
- Supportive Skill Building: September 25, 2024, 11AM - 12PM EST Recording and Presentation (PDF)
- Therapeutic Interventions: September 27, 2024, 9:30AM - 10:30AM EST Recording and Presentation (PDF)
- Personal Support Services: October 7, 2024, 3PM - 4PM EST Recording and Presentation (PDF)
- Rehabilitative Services: October 9, 2024, 10:30AM - 11:30AM EST Recording and Presentation (PDF)
Engagement Series Questions & Answers (PDF) - Updated 10/29/20024
Survey Training Recording - 10/22/2024
Rationale: Align rates of similar services across sections and Department goal to address severe state labor shortages for nurses which has contributed to a decline in utilization of services, despite increased need.
Services: Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology, and Personal Support Services.
Effective Date: TBD
Next Rate Adjustment: TBD
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CY 2024 Rate Determinations - Upcoming
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Section of Policy
Status
Other Information
Section TBD, Coordinated Specialty Care Internal Planning Rationale: P.L. 2021, Ch. 398, Part A, provides funding to implement a coordinated specialty care model, to treat MaineCare members for a first episode of psychosis.
Services:
Section 106, School-Based Health Center Services & 65, Multi-Dimensional Family Therapy (MDFT) Internal Planning Rationale: P.L. 2021, Ch. 227, to address health-related services that are required for children ages 0-5 years, to access their education. This must be a major substantive rule. Additionally, the Children's Behavioral Health Services plan calls for MDFT services to be implemented under section 65. Finally, P.L. 2023, Ch. 412, Part A, provides funding for implementation.
Services:
Ch. I, Section 1, Interpreter Services Internal Planning Rationale: With Maine's growing population and expansion of MaineCare, a review is necessary to ensure quality of care and to ensure access to this critical service, especially during times of trauma and urgency.
Services: Interpreter Services
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Prior Rate Reform Actions To Date
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Public Notices
Presented Materials and Other Documents
Other Information
Section 23, Developmental and Behavioral Clinic Services - Child Abuse Evaluations Initiation and Public Forum Invite - 5/13/2024
Comment Deadline - 5/17/2024
Draft Rate Public Forum Draft Rate Model (PDF) and Recording - 5/17/2024
Comment Summary with Department Response (PDF) and Final Draft Rate (PDF) - 5/30/2024
Rationale: The Department is conducting this rate determination to improve member access to this service.
Services: Child Abuse Evaluation Service
Effective Date: Pending rulemaking
Next Rate Adjustment: Pending rulemaking
Further Section Change Needed:
Section 23, Developmental and Behavioral Clinic Services, New Service - Foster Care Comprehensive Assessments Initiation 10/14/2022
Draft Rate, public comment 11/23/2022
Draft Rates Posted and Comment Deadline 12/2/2022
Final Draft Rates and Comment Summary 1/11/2024
Foster Care Comprehensive Health Assessment Forum Presentation (PDF) 11/30/2022
Section 23 Forum Recording 11/30/2022
Final Draft Rate Model (PDF) 1/11/2024
Comment Summary 1/11/2024
Rationale: New service to conform with 22 MRSA Section 4063-A (3) requirement that the comprehensive assessment at the time a child enters state custody be reimbursed under MaineCare
Services: Foster Care Comprehensive Health Assessment
Effective Date: Pending rulemaking
Next Rate Adjustment: Pending rulemaking
Further Section Change Needed: Other services in Section will need review.
Section 71, National Diabetes Prevention Program
Initiation 12/16/2022
Draft Rate/Public Comment Invite - 12/29/2022
Posting of Final Draft Rate and Comment Summary 4/28/2023
UPDATED Proposed Rates - 9/1/2023
Notice of Agency Rulemaking Adoption 11/8/2023
Draft Rate/Public Comment (PDF) - 2/6/2023
Draft Rate/Public Comment Recording - 2/6/2023
Comment Summary with Department Response (PDF) - 4/25/2023
Final Draft Rates (PDF) - 4/25/2023
Rationale: P.L. 2021, Ch. 398, Sec. A-17
Services: All
Effective Date: November 8, 2023
Next Rate Adjustment: In coordination with Medicare
Further Section Change Needed: None
Section 2, Adult Family Care Homes
Initiation 8/11/2022
Kickoff and survey overview (direct email) 8/11/2022
Survey results (direct email) 10/24/2022
Draft Rate Public Review and Comment 11/22/2022
Comment Summary with Department Response and Final Draft Rates 4/18/2023
Implementation of January 1, 2023 Rate Study Increases 4/20/2023
Kickoff Recording & Presentation (PDF) - 8/31/2022
Survey Results (PDF) - 10/22/2022
Draft Rate/Public Comment Recording - and Presentation (PDF) - 1/12/2023
Comment Summary (PDF) - 4/14/2023
Final Draft Rate Model (PDF) - 4/14/2023
Rationale: P.L. 2021 Ch.398, Part AAAA
Services: All
Effective Date: 1/1/2023 implementation of AAAA rate
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
Section 13, Targeted Case Management
Initiation 9/01/2022
Kickoff and survey overview 3/11/2022
Survey distributed 4/22/2022
Draft Rate, public comment 9/01/2022
Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022
Final Draft Rates Posted - December 30, 2022
Kickoff Recording (included all BH sections) - May, 2022
Survey Results (PDF) - 10/5/2022
9/20/2022:
- Draft Rate Models (PDF)
- Draft Rate/Public Comment Recording
- Draft Rate/Public Comment Presentation (PDF)
Comment Summary with Department Response (PDF) - 5/22/2023
Final Rate Model (PDF) - 5/22/2023
Rationale: Department priority (appropriation in P.L. 2021, Ch. 635)
Services: All
Effective Date: 1/1/2023
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
Section 17, Community Support
Initiation 9/1/2022
Kickoff and survey overview 3/11/2022
Survey distributed 4/22/2022
Draft Rate,public comment invite 9/1/2022
Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022
Final Draft Rates Posted - December 30, 2022
Kickoff Recording (included all BH sections) - May, 2022
Survey Results (PDF) - 10/5/2022
(13, 17, & 92) 9/20/2022:
- Draft Rate Models (PDF)
- Draft Rate/Public Comment Recording
- Draft Rate/Public Comment Presentation (PDF)
(17, 28 & 65 Community-Based MH & SUD) 9/23/2022:
- Draft Rate/Public Comment Recording
- Draft Rate/Public Comment Presentation (PDF)
- Draft Rate Models (PDF)
Comment Summary with Department Response (PDF) - 5/22/2023
Final Rate Model (PDF) - 5/22/2023
Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635
Services: All
Effective Date: 1/1/2023
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
Section 26, Day Health Services
Initiation 8/11/2022
Kickoff and survey overview (direct email) 8/11/2022
Survey results (direct email) 10/24/2022
Draft Rate Public Review and Comment 11/2/2022
Comment Summary with Department Response 4/3/2023
Kickoff Recording and Presentation (PDF) - 8/31/2022
Survey Results (PDF) - 10/24/2022
Draft Rate/Public Comment Recording and Presentation (PDF) - 11/17/2022
Comment Summary - 3/16/2023
Final Draft Rates - 12/27/2022
Rationale: P.L. 2021 Ch.398, Part AAAA
Services: All
Effective Date: 1/1/2023
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
Section 28,
Initiation 9/01/2022
Kickoff and survey overview 3/11/2022
Survey distributed 4/22/2022
Draft Rate, public comment 9/01/2022
Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022
Final Draft Rates Posted - December 30, 2022
Kickoff Recording (included all BH sections) - May, 2022
Survey Results (PDF) - 10/5/2022
17, 28 & 65 Community-Based MH & SUD 9/23/2022:
- Draft Rate/Public Comment Recording
- Draft Rate/Public Comment Presentation (PDF)
- Draft Rate Models (PDF)
Comment Summary with Department Response (PDF) - 5/22/2023
Final Rate Model (PDF) - 5/22/2023
Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635
Services: All
Effective Date: 1/1/2023
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
Section 60 DME (Phase I)
Initiation - 9/27/2022
Draft Rate, public comment - 11/22/2022
Draft fee schedule and methodology - 11/23/2022
Summary of Comments with Department Response - 2/06/2023
Billing Guidance and Corrections - 3/23/2023
Public Forum Presentation (PDF) 12/01/2022
Public Forum Recording 12/01/2022
Draft Rate Methodology (PDF) 12/01/2022
Draft Fee Schedule (PDF) 12/01/2022
Rate Forum Comments and Responses (PDF) 2/6/2023
Final Draft Fee Schedule (1/5/2023)
Rationale: Department priority (appropriation in P.L. 2021, Ch. 635)
Services: 100% of Medicare, rural/non-rural, and DME index COLA for non Medicare
Effective Date: 1/1/2023
Next Rate Adjustment: annually, in coordination with Medicare.
Further Section Change Needed: Non-Medicare covered codes
Section 65, Behavioral Health
Initiation 9/01/2022
Kickoff and survey overview 3/11/2022
Survey distributed 4/22/2022
Draft rate, public comment 9/01/2022
Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022
Final Draft Rates Posted - December 30, 2022
Kickoff Recording (included all BH sections) - May, 2022
Survey Results (PDF) - 10/5/2022
65 Adult and Children Outpatient & School Health Related Services 9/21/2022:
- Draft Rate Models (PDF)
- Draft Rate/Public Comment Presentation (PDF)
- Draft Rate/Public Comment Recording
17, 28 & 65 Community Based Mental Health & SUD Services 9/23/2022:
- Draft Rate Models (PDF)
- Draft Rate/Public Comment Presentation (PDF)
- Draft Rate/Public Comment Recording
Comment Summary with Department Response (PDF) - 5/22/2023
Final Rate Model (PDF) - 5/22/2023
Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635
Services: All
Effective Date: 1/1/2023
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
Section 65, Crisis Residential and Resolution
Initiation 9/01/2022
Kickoff and survey overview 3/11/2022
Survey distributed 4/22/2022
Draft rate public review, written comment 11/16/2022
Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022
Final Draft Rates Posted - December 30, 2022
Kickoff Recording (included all BH sections) - May, 2022
Crisis Survey Analysis 11/7/2022
Draft Rate Model (PDF) - 11/22/2022
Draft Rate Public Review Recording - 11/22/2022
Comment Summary with Department Response (PDF) - 5/22/2023
Final Rate Model - 5/22/2023
Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635
Services: Crisis Services
Effective Date: Crisis Residential only 1/1/2023
Next Rate Adjustment: TBD
Further Section Change Needed: Work on Crisis Resolution is ongoing into 2023
Section 92, Behavioral Health Homes
Initiation 9/01/2022
Kickoff and survey overview 3/11/2022
Survey Distributed 4/22/2022
Draft Rate, public comment 9/01/2022
Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022
Final Draft Rates Posted - December 30, 2022
Kickoff Recording (included all BH sections) - May, 2022
Survey Results (PDF) - 10/5/2022
(13, 17, & 92) 9/20/2022:
- Draft Rate Models (PDF)
- Draft Rate/Public Comment Recording
- Draft Rate/Public Comment Presentation (PDF)
Comment Summary with Department Response (PDF) - 5/22/2023
Final Rate Model (PDF) - 5/22/2023
Rationale: Ensure equitable rates across behavioral health sections and help address DOJ findings.
Services: All
Effective Date: 1/1/2023
Next Rate Adjustment: COLA Annually in January
Further Section Change Needed: None
31 Federally Qualified Health Centers (Rebasing) Initiation 9/27/2022
Provider Kickoff (direct invite to MPCA) 10/17/22
Draft Rates/Public Comment Invite 3/27/2023
Billing Guidance & Implementation Timing for Updated Payment Methodology 5/01/2023
Implementation of 3/01/2023 rates 5/12/2023
Kickoff Meeting Recording - 10/17/2022
LD 1787 Presentation (PDF) - 1/18/ 2023
LD 1787 Meeting Recording - 1/18/2023
Stakeholder Infomational Recording - 2/1/2023
Stakeholder Informational Presentation (PDF) - 2/1/2023
Stakeholder Informational Recording - 2/21/2023
Draft Public Forum Presentation (PDF) - 3/30/2023
Draft Public Forum Presentation Recording - 3/30/2023
Comment Summary with Department Response (PDF) - April 23, 2024
Rationale: P.L. 2021 Ch. 747
Services: All
Effective Date: 3/1/2023
Next Rate Adjustment: Annually in July
Further Section Change Needed: None
Section 5 Ambulance Services
Ambulance Reimbursement Effective 4/1/2022 and Billing Guidance 3/16/2022
(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Rationale: Legislation, 2021 Resolve, Ch. 118 Resolve to provide add on payments for ambulance services reimbursed by MaineCare.
Services: Medicare Covered Services
Effective Date: 4/01/2022
Next Rate Adjustment: Updated annually in January in Coordination with Medicare
Further Section Change Needed: Non-Medicare Codes/Services
Sections 13, 17, 23, 28, 30, 40, 65, 91, 92, 93, 97-App D Therapeutic Foster Care, 102
MaineCare Cost of Living Adjustments and Medicare Standardization Effective July 1, 2022 – 6/03/2022
(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Rationale: Legislation, PL. 2021, Ch 635, Part A.
Services: COLA Rate Adjustments (4.94% equal to the percentage increase in the state minimum wage for January 1, 2022)
Effective Date: July 1, 2022
Next Rate Adjustment:Annual COLA in January (sections 13, 17, 28, 65, 92.)
Annual COLA in July (sections 23, 30, 40, 91, 93, 97 B&D & 102)
Further Section Change Needed: All behavioral health sections have been addressed in a recently closed 2022 Rate Study. Other sections are currently in progress or upcoming for rate determinations in CY 2023 (except for section 91 Health Home Services).
Sections 14, 15, 68, 75, 85, 90, 95, 101, 109
MaineCare Cost of Living Adjustments and Medicare Standardization Effective July 1, 2022 – 6/03/2022
(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Rationale: Comprehensive Rate Study Evaluation: areas of greatest need, Inconsistent, inequitable reimbursement across sections, and Standardized percentage of Medicare (72.4%) and use of current year’s rates
Services: Medicare covered services
Effective Date: July 1, 2022
Next Rate Adjustment: Annually in January in Coordination with Medicare
Further Section Change Needed: Non-Medicare codes need to be addressed
Section 25, Dental
Draft Dental Reform Methodology (PDF)
Dental Provider Forum Presentation (PDF)
Dental Rate Forum Presentation (PDF) and Recording
Dental Policy Forum Presentation (PDF) and Recording
Rationale: Comprehensive Rate Study Evaluation: areas of greatest need
Services: Comprehensive adult and children’s dental
Effective Date: July 1,2022
Next Rate Adjustment: July: benchmark assessment biennially. COLA (biennially).
Further Section Change Needed: None needed. Benchmarks will be assessed biennially.
Section 67, Nursing Facility Services
NF/RCF Rate Letters and 125% Minimum Wage Adjustments - 6/30/2022
(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Rationale: Legislation: Section AAAA-5, 2021 P.L. Ch. 398
Services: 125% min wage adjustment
Effective Date: July 1, 2022
Next Rate Adjustment: Annually in January (AAAA adjustment), Annually in July, (COLA)
Further Section Change Needed: Upcoming Rate Study to address the current administratively burdensome cost settlement system and to address lack of incentive for quality of care and to reward cost effectiveness.
Section 97, Appendix C, Medical Remedial (RCF)
NF/RCF Rate Letters and 125% Minimum Wage Adjustments6/30/2022
(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Rationale: Legislation
Services: RCF 125% min wage adjustment
Effective Date: July 1, 2022
Next Rate Adjustment: January 1, 2023 (AAAA adjustment-not inflation)
Further Section Change Needed: Upcoming Rate Study to address the current administratively burdensome cost settlement system and to address lack of incentive for quality of care and to reward cost effectiveness.
Section 97, Appendix B, Substance Use Disorder Residential Services PNMI B Final Draft Rates Notice - 8/27/2021 This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Rationale: 1115 Demonstration Waiver (Maine's Substance Use Disorder Care Initiative)
Services: All
Effective Date: November 1, 2021
Next Rate Adjustment: Annual COLA in July
Further Section Change Needed: none
Section 97, Appendix D, Children's Residential Care Facility PNMI D Proposed Changes and Final Draft Rate Notice 8/13/2021
(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)
Survey Analysis (PDF) - 3/03/2021
Cost Report Analysis (PDF) - 3/03/2021
Response to Public Comments (PDF) - 8/06/2021
Final Rate Models (PDF) - 8/06/2021
Rationale: Outdated legacy rate models and new federal quality standards
Services: Residential Care
Effective Date: November 1, 2021
Next Rate Adjustment: Annual COLA in July
Further Section Change Needed: Therapeutic Foster Care. (Planned study 2023)
Section 89, MaineMOM (New Service)
Informational Session on Proposed MaineMOM Services and Reimbursement 3/18/2022
(This service developed prior to P.L. 2022 Ch. 639 becoming effective)
MaineMOM Advisory Group Presentation (PDF) 9/15/2020
Rationale: New service
Services: Integrated opioid tx and perinatal care for pregnant/ postpartum people/ their infants
Effective Date: Rulemaking in progress
Next Rate Adjustment: To Be Determined
Further Section Change Needed: None needed
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Cost-of-Living Adjustments (COLA) and Medicare Standardization
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A schedule of COLA/Medicare Standardization updates per section of policy is coming soon!
Background
In 2019, DHHS and MaineCare launched a Comprehensive Rate System Evaluation (CRSE) to serve as the basis to inform policy making and improve members’ health and the program’s sustainability by comprehensively evaluating rates and promoting high-value services.
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Evaluation
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The evaluation found that many rates were outdated and inconsistent, some with no known basis or methodology. It also found significant inconsistencies in methodology and timelines for rate adjustments between services.
The evaluation made a number of recommendations that were ultimately codified in law in P.L. 2021 Ch. 639, which was enacted in 2022. Specifically, Ch. 639:
- Sets a schedule for regular rate review and adjustment.
- Establishes the MaineCare Rate Reform Expert Technical Advisory Panel (TAP) for consultative purposes.
- Establishes a rate system sub-committee to the MaineCare Advisory Committee (MAC).
- Formalizes a clear and transparent process for rate determination via public notice, presentation, and comments (as well as public response to comments) on proposed rates.
- Ensures review of relevant state and national data to inform rate amounts and payment models, with emphasis on models that promote high value services by connecting reimbursement to performance.
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Annual Rate Determination Schedule Process
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As mandated, the Department must annually develop a schedule of rate determination in consultation with the Technical Advisory Panel (TAP). The Department must then post the proposed rate determination schedule on its publicly accessible website, provide an opportunity for the public to review and comment on the rate determination schedule, and make available a summary of these comments on its publicly accessible website. The Department then posts the final rate determination schedule.
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Annual Rate Determination Schedules: Presented Materials and Associated Notices
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Interested parties are encouraged to review presented materials for additional context and rationale pertaining to the proposed schedule.
CY 2024
- TAP Consultation and Public Stakeholder Forum on Draft Rate Determination Schedule E-Message
- Video of (TAP) Consultation - October 4, 2023
- TAP Consultation (PDF)
- Proposed Annual Rate Determination Schedule (PDF)
- Public and Written Comment Summary (PDF)
- Final Rate Determination Schedule CY24 (PDF)
- Letter from OMS Director Michelle Probert (PDF)
- E-Message - December 8, 2023
CY 2023
- TAP Meeting and Public Stakeholder Forum on Draft Rate Determination Schedule E-Message
- Video of (TAP) Consultation - October 13,2022
- TAP Consultation (PDF)
- Proposed Annual Rate Determination Schedule (PDF)
- E-Message - October 22, 2022
- Video of Public Forum or Interested Parties to Comment on Proposed Schedule - October 26, 2022
- Public Forum Presentation (PDF)
- Public and Written Comment Summary (PDF)
- E-Message - November 23, 2022
- Final Rate Determination Schedule CY 2023 (PDF)
- E-Message - December 9, 2022
- Letter from OMS Director Michelle Probert (PDF)
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Past Announcements
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- Rate System Timeline and Deliverables (PDF) - November 24, 2020
- Rate System Evaluation Update (PDF) - August 27, 2020
- Rate System Evaluation Announcement - January 21, 2020
- MaineCare Rate System Evaluation
Frequently Asked Questions (FAQs)
Sections 17, 28, and 65 Rate Adjustment FAQ (PDF) - Updated February 8, 2024
Service Provider Tax Repeal Affected Code List (PDF)
Service Provider Tax Repeal FAQs (PDF)