MaineCare reimburses health providers for care and treatment they provide to MaineCare members. This includes a wide range of providers, from hospitals and primary care clinics to therapists, behavioral health and substance use disorder treatment facilities, and nursing facilities, among many others. Over the years, MaineCare has used varying methods to determine reimbursement rates to providers, which has contributed to a rate system that is fragmented and outdated. Therefore, MaineCare conducted an evaluation of its rates and rate setting system and has developed the first stage of its plan for the creation of a comprehensive, streamlined, and coherent system that will support MaineCare members' access to high-value services. The evaluation included all MaineCare services, with the exception of pharmacy and non-emergency transportation services, as these reimbursement rates are determined by the federal government.
- DHHS MaineCare Rate System Reform Part Two Biennial Budget Proposal
DHHS’ MaineCare Rate Reform proposal reflects the Department’s approach to implementing its first phase of investment in MaineCare’s rates and rate system in response to vendor Myers and Stauffer’s recommendations resulting from the Department’s Comprehensive Rate System Evaluation. The budget proposal aims to increase provider payment rates for dozens of services; takes the first step toward rationalizing, updating and simplifying how MaineCare pays for services; and dedicates resources to conduct service-specific rate reform studies this biennium for services identified as top priority in the need for near-term development of data-driven, value-based payment rates.
Next Steps in MaineCare’s Rate System Reform Plan
The Department will engage with stakeholders later this summer and fall to:
- Formalize a long-run schedule for regular rate adjustments. This will include an LD for 2022 that includes creation of a Technical Advisory Panel to review recommended schedules and adjustments
- Receive input on the next phase of priority services for further rate study and implementation of adjustments.
- March 2021 Implementation Planning Report
In this final report, the Comprehensive Rate System Evaluation Implementation Planning Report (PDF), Myers and Stauffer builds upon work completed to date to provide estimates of the time and level of effort needed to implement the recommendations. The Report expands upon the priority table in the Interim Report that summarizes the policy section-specific recommendations along with the broader recommendations for the system that extend beyond individual policy sections. The CRSE Implementation Report also takes the additional step of adjusting the priorities from the Interim Report, where appropriate, to reflect the impact of DHHS initiatives that have recently been implemented, are in progress, or that have been proposed as initiatives in the FY22/23 biennial budget. This document provides a starting point for the Department as it reviews these recommendations for potential adoption and assesses the steps needed to implement each recommendation.
- Interim Report
The Comprehensive Rate System Evaluation Interim Report (PDF) which was updated on January 26, 2021 and includes a number of interim recommendations for how MaineCare can establish and maintain reimbursement rates that promote members’ access to high-quality care and accurately account for Maine health care providers’ costs. The Department is currently reviewing the interim recommendations included in this report. A final report will be issued at the end of February that may include refinements to some individual recommendations and will include a more detailed implementation plan.
- Phase 1 Benchmarking Report
- Stakeholder Engagement Meetings
Phase 2 Stakeholder Engagement Meetings
Phase 2 Stakeholder Engagement Meeting Recordings
- Dental Services - December 2, 2020
- Specialty Services - December 2, 2020
- Hospital Services - December 3, 2020
- Nursing Facilities - December 3, 2020
- Miscellaneous Services - December 4, 2020
- Physician, APRN, Primary Care, Ambulatory Care/Clinic Services - December 4, 2020
- Residential Care Services - December 4, 2020
- Outpatient Behavioral Health - December 7, 2020
- Community Based Behavioral Health - December 7, 2020
- HCBS for Members with IDD and/or Acquired Brain Injury - December 8, 2020
- HCBS for Older Adults and Members with Physical Disabilities - December 8, 2020
Phase 1 Stakeholder Engagement Meetings
Phase 1 Stakeholder Engagement Meeting Recordings
- Miscellaneous Services - October 5, 2020
- Physician, APRN, & Primary Care Services - October 5, 2020
- Outpatient Behavioral Health Services - October 6, 2020
- HCBS for Older Adults and Members with Physical Disabilities - October 7, 2020
- HCBC for Members with IDD, Acquired Brain Injury and Other Related Conditions - October 7, 2020
- Community Behavioral Health Services - October 8, 2020
- Hospital Services - October 8, 2020
- Specialty Services - October 8, 2020
- Residential Care - October 9, 2020
- Nursing Facilities - October 9, 2020
- Ambulatory Care/Clinics - October 9, 2020
For have questions, comments, or notice errors in any of the reports and associated documents, please send an email to: RateSettingEval@maine.gov.