Project Purpose
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methods to determine reimbursement rates to providers, which has contributed to a rate system that is fragmented and outdated.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.
Rate System Timeline and Deliverables (PDF)
- Phase 1 Benchmarking Report
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Content coming soon!
- Stakeholder Engagement Meetings
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Phase 2 Stakeholder Engagement Meetings
Schedule and Overview (PDF)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
Questions?
For more information, please contact Peter Kraut.