Date posted:
Attachment(s):
Notice of Agency Rulemaking Proposal
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND RULE TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual (MBM) [Ch. I, Sec. 1, General Administrative Policies and Procedures]
TYPE OF RULE: Routine Technical
PROPOSAL FILING NUMBER: 2026-P195
BRIEF SUMMARY: This rulemaking is proposed via two, simultaneous private citizen petitions submitted to the Office of MaineCare Services (OMS) on June 23, 2026, to adopt or modify a rule. The petitioners provided the specific rule changes proposed here as part of their petitions. Under 5 M.R.S. § 8055, the Department of Health and Human Services (Department) is required to initiate rulemaking proceedings on the petitioners’ proposals within 60 days because each petition was signed by 150 or more registered voters. Because the Department may only propose one set of amendments to a rule at any given time, this rulemaking combines the two petitioned rule amendments into a single rulemaking.
The proposed rule would amend Chapter I, Section 1 of the MaineCare Benefits Manual (MBM) to require the Department to conduct in-person, On-Site Reviews and On-Site Inspections of MaineCare provider business or service locations and authorize the Department to impose sanctions when a provider fails to permit access to the Department for such On-Site Visit, Review, or Inspection. The proposed rule would require the Department to suspend a MaineCare provider’s claims payments, under defined criteria, and to escrow withheld payments upon notice of improper payment with the issuance of a Payment Suspension and Escrow Order (PSEO). The rule proposes to escrow such suspended and hold payments until a final determination is made as to the existence and amount of any improper payment. The petitioners also propose that the Department require providers under payment suspension to continue to deliver medically necessary covered services to current MaineCare members.
The petitioners also propose that the Department work with the Centers for Medicare & Medicaid Services to obtain any necessary approvals to amend the State Plan to enact these reforms.
PUBLIC HEARING: The Department will hold a combined in-person and remote (via Zoom) public hearing.
Date and time: Thursday, September 10, 2026, 8:30 AM to 11:30 AM
Location: State Office Building, Conference Rooms A and B, 109 Capitol Street, Augusta, ME
Zoom Meeting Link: https://mainestate.zoom.us/j/82472273200
COMMENT DEADLINE: Sunday, September 20, 2026
CONTACT PERSON FOR THIS FILING:
Heather Pelletier, MaineCare Policy Manager
Office of MaineCare Services
11 State House Station, 109 Capitol Street
Augusta, ME. 04333-0011
TEL: (207) 624-4074, Fax: (207) 287-6106 TDD/TTY: 711
Proposed
Office: MaineCare Services
Routine technical
Email: heather.pelletier@maine.gov
Comment deadline:
Off
The comment period for this rule has closed.