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The Department identified an error in the capital cost calculations on the NF rate letters. Revised rate letters are now available on the secure Health PAS Online Portal.
Effective January 1, 2026, the MaineCare Orthodontia Pro-Rate Request Form is updated on the Manuals, Forms, and Criteria Sheets page of the Health PAS Online Portal.
This updated form reduces the administrative burden for providers and the Department when a prior authorization for Comprehensive or Limited Orthodontic treatment must be repriced because treatment stops before it is completed.
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.
As previously noticed, MaineCare is increasing RHC reimbursement rates to reflect a 1.0% COLA. We will implement these new rates by January 7, 2026, and adjust all affected claims. No provider action is required.
As previously noticed, MaineCare will update RCF direct care rates to reflect a 1.0% COLA. We will implement these new rates by February 1, 2026.
Effective January 1, 2026, updated rate letters are accessible on the secure Health PAS Online Portal.
For questions on these rates, please contact the individual listed on the rate letters.
As previously noticed, MaineCare will update NF direct care and routine rates to reflect a 1.0% COLA. We will implement these new rates by February 1, 2026.
Effective January 1, 2026, updated rate letters are accessible on the secure Health PAS Online Portal.
For questions on these rates, please contact the individual listed on the rate letters.
Effective October 18, 2025, we completed the CMS quarterly updates for DRGs in MIHMS. Updates are as follows:
Effective December 22, 2025, we completed the CMS quarterly updates for APCs in MIHMS. The following CMS documents provide the details about the APC updates.
Referral Process
Beginning February 2, 2026, Single Assessment Referral will be the required statewide process for determining eligibility for children’s medium- and high-intensity behavioral health services, as required under Maine’s Children’s Behavioral Health Services Settlement Agreement.
The Single Assessment is a standardized approach to assessing a child’s behavioral health needs and identifying the appropriate level of care and clinically indicated services for children who require medium- to high-intensity behavioral health services.
The Department has initiated a Rate Determination Process* for Doula Services. This is a newly covered service with the section of the MaineCare Benefits Manual to be determined. Rates are being determined pursuant to LD 1523 “Resolve, to Develop MaineCare Coverage for Doula Services” and in alignment with Maine’s participation in the Transforming Maternal Health (TMaH) Model, led by the Centers for Medicare & Medicaid Services.
The Department initiated a Rate Determination Process* for MaineCare Benefits Manual (MBM), Section 43: Hospice Services.
Reimbursement rates are being determined pursuant to P.L. 2025, Ch. 388. Opportunities to further align Hospice Services with Medicare requirements and improve access to Hospice care will be explored during the rate determination process.