Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, January 1, 2026 Cost-of-Living Adjustment
NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment to increase reimbursement rates for the following sections by a 1% cost-of-living adjustment (COLA) which was appropriated by the Maine State Legislature.
|
Section |
Title |
|
Section 2 |
Adult Family Care Services |
|
Section 12 |
Consumer Directed Attendant Services |
|
Section 13 |
Targeted Case Management Services |
|
Section 17 |
Community Support Services |
|
Section 26 |
Day Health Services |
|
Section 28 |
Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations |
|
Section 60 |
Medical Supplies and Durable Medical Equipment (only certain services where reimbursement rates are not benchmarked to Medicare) |
|
Section 65 |
Behavioral Health Services |
|
Section 67 |
Nursing Facility Services (direct and routine care rates only) |
|
Section 90 |
Physician Services (only certain services where reimbursement rates are not benchmarked to Medicare) |
|
Section 92 |
Behavioral Health Home Services |
|
Section 96 |
Private Duty Nursing and Personal Care Services |
|
Section 103 |
Rural Health Clinic Services APM |
Additionally, as a result of these reimbursement changes, the Department will also increase the Private Duty Nursing (Section 96) level of care caps by an amount proportional to the reimbursement changes. The cap increases are to ensure that members maintain appropriate access to covered services.
REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2025 Ch. 388 - An Act Making Unified Appropriations and Allocations from the General Fund and Other Funds for the Expenditures of State Government and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2025, June 30, 2026 and June 30, 2027
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $1,808,385 in federal fiscal year 2026 which includes $1,157,746 in federal funds and $650,639 in state funds, and will cost $7,233,543 in federal fiscal year 2027 which includes $4,583,838 in federal funds and $2,649,705 in state funds.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926.
CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
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