• Read more about Rate Determination Initiation Notice and Public Forum for Section 97, Private Non-Medical Institutions (PNMI) Appendix D, Temporary High Intensity Services

The Department initiated a Rate Determination Process* for Temporary High Intensity Services under Section 97, PNMI, Appendix D (Children’s Residential Care) of the MaineCare Benefits Manual. The Department will assess and determine as appropriate, rate amounts or reimbursement models in accordance with Rate Reform law. 

Draft Rate and Model Presentation and Comments Deadline

• Read more about CoverME.gov's Fourth Annual Open Enrollment Ends with Record Number of New Enrollees

Nearly 65,000 Maine residents enrolled in affordable coverage for 2025 during open enrollment

• Read more about Home and Community Based Service (HCBS) Providers of Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology & Personal Support Services: Draft Rate Public Review and Comment

In June of 2024, the Department initiated a rate determination process for certain HCBS under policy sections 12, 18, 19, 20, 21, 29, 40, 96, and 102. This rate determination included a public kickoff, several engagement sessions, and a survey to obtain information, including but not limited to, program costs and service utilization from providers and interested parties.  

• Read more about Calendar Year (CY) 2025 Rate Determination Schedule

Annually, MaineCare develops a schedule of rate determinations for the upcoming CY. A DRAFT Rate Determination Schedule is now available for public review.  

Next Steps 

Jan 1, 2025

Caregiver assessments and flexible benefits contributed to the pilot’s success.

• Read more about Respite for ME Final Evaluation Confirms Positive Impact of Pilot Program on Family Caregivers and Older People in Maine

• Read more about Correction to Section 67, Nursing Facility Rate Letters Published on January 16, 2025

The Department has identified an error in the Patient Driven Payment Model (PDPM) calculations, found in the table on page 3 of the rate letter. We will post revised rate letters on the secure Health PAS Online Portal next week.   

For questions, please contact Amanda Lee, Rate Setting Coordinator. 

• Read more about Attention Providers of Section 21 Agency Home Support: Information About Staffing Thresholds

This message confirms that as of January 1, 2025, the Department is enforcing the 92.5% minimum staffing threshold for Agency Home Supports under MaineCare Benefits Manual, Section 21. Enforcement of this standard was deferred from July 1, 2024 to December 31, 2024, due to labor market conditions. The Department analyzed Agency Home Support and determined that per person units delivered now surpass pre-pandemic levels, indicating an easing of staffing challenges. Please see the notice from June 28, 2024 for more

• Read more about Correction to ​Hospital Outlier Payment Methodology, CR 128941

We implemented a system update that changed the Diagnostic Related Groups (DRG) hospital outlier methodology in error. This affected claims with dates of service from July 1, 2024, through December 31, 2024. We will adjust affected claims, and no provider action is needed. 

• Read more about Nursing Facilities (NFs) and Residential Care Facilities (RCFs), PNMI, Appendix C Rate Letters

Effective January 1, 2025, you can find NF and RCF rate letters on the secure Health PAS Online Portal. We will implement these new rates by February 1, 2025.

Attention RCFs:

MaineCare updated RCF rates to reflect the removal of the Service Provider Tax (SPT) from the direct care rate and updated the fixed costs based on the most recent audited cost reports.

For questions about the rates, please contact the individual listed on the rate letter.

• Read more about Revision of Medicare Standardization Rates

Effective January 1, 2025, the Centers for Medicare & Medicaid Services (CMS) revised certain rates. To align with these changes, MaineCare is in the process of revising reimbursement rates for Medicare covered codes and services, in the sections listed below. The new rates will reflect 72.4% of the Medicare rates with a retroactive effective date of January 1, 2025, to align with Medicare. Providers can expect these new rates to be implemented by the end of January 2025.