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methods to determine reimbursement rates to providers, which has contributed to a rate system that is fragmented and outdated.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 is conducting an evaluation of its rates and rate setting system and developing a plan for the creation of a comprehensive, streamlined, and coherent system that will support MaineCare members' access to high value-services. The evaluation will include all MaineCare services with the exception of Pharmacy and Non-Emergency Transportation.
See the Rate System Evaluation Update for more information on this process, the schedule, and stakeholder engagement efforts.
- 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.