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, Section 45 – Hospital Services
NATURE OF PROPOSED CHANGES: The Department plans to submit a State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to implement a one-time supplemental payment to acute care hospitals for inpatient services. The one-time supplemental payment will total $6,348,400 in fiscal year 2027. This supplemental payment will be distributed, upon CMS approval, to each eligible hospital based on their relative share of MaineCare payments identified on MaineCare cost reports for state fiscal year 2024. These payments will not be subject to cost settlement.
Additionally, the Department plans to implement a 3.70% cost-of-living adjustment for inpatient diagnosis-related group reimbursement rates subject to rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 45 effective July 1, 2026.
REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2025, Ch. 650, An Act Making Supplemental 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, 2026 and June 30, 2027.
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $3,093,338 in federal fiscal year 2026 which includes $2,022,905 in federal funds and $1,070,433 in state funds, and will cost $18,721,751 in federal fiscal year 2027 which includes $11,868,972 in federal funds and $6,852,779 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 https://www.maine.gov/dhhs/about/rulemaking for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: kristin.merrill@maine.gov
Comment deadline:
Off