To provide a clear and transparent process for MaineCare rate determinations, with opportunities for robust participation from all interested stakeholders.
We will be updating this page with important dates and progress made on past, current, and future rate determination work. Please check in often, as this site is a work in progress.
MaineCare Rate Determination Schedule
As mandated, the Department must annually develop a schedule of rate determination in consultation with the Technical Advisory Panel (TAP). The Department must then post the proposed rate determination schedule on its publicly accessible website, provide an opportunity for the public to review and comment on the rate determination schedule, and make available a summary of these comments on its publicly accessible website.
The Department has posted the presentation to the TAP, which we encourage interested parties to review as it contains additional context and rationale pertaining to the proposed schedule.
- TAP Meeting and Public Stakeholder Forum Notice
- Video of TAP Meeting October 13, 2022 (YouTube)
- Proposed Annual Rate Determination Schedule (PDF)
Virtual Rate Determination Proposed Schedule Public Forum
The Department is held a virtual public forum for interested parties to comment on the proposed schedule.
- Comments were submitted through November 9, 2022
- A summary of comments can be found here (PDF)
- The Department will post its final schedule for rate determinations to be initiated through calendar year 2023 in December 2022.
- Rate Determination Initiation Notices Sent Out to Date
- Section 2, Adult Family Care Homes
- Section 13, Targeted Case Management
- Section 17, Community Support Services
- Section 23, Developmental and Behavioral Health Services – New Service, Foster Care Comprehensive Health Assessment
- Section 26, Day Health
- Section 28, Rehabilative and Community Support Services for Children with Cognitive Impairments and Functional Limitations
- Section 31, Federally Qualified Health Centers (FQHC)
- Section 45, Hospital Services
- Section 60, Medical Supplies and Durable Medical Equipment
- Section 65, Behavioral Health Services
- Section 92, Behavioral Health Home Services
- Section 107, Psychiatric Residential Treatment Facility
Section 23 - Developmental and Behavioral Clinic Services: New Service Foster Care Comprehensive Health Assessment
MaineCare is currently updating MaineCare Benefits Manual, Chapter II, Section 23 Foster Care Comprehensive Health Assessment reimbursement methodology as part of our rate reform initiatives. Please see the Public Forum Presentation (PDF).
In 2019, DHHS and MaineCare launched a Comprehensive Rate System Evaluation (CRSE) to serve as the basis to inform policy making and improve members’ health and the program’s sustainability by comprehensively evaluating rates and promoting high-value services.
The evaluation found that many rates were outdated and inconsistent, some with no known basis or methodology. It also found significant inconsistencies in methodology and timelines for rate adjustments between services.
The evaluation made a number of recommendations that were ultimately codified in law in P.L. 2021 Ch. 639, which was enacted in 2022. Specifically, Ch. 639:
- Sets a schedule for regular rate review and adjustment.
- Ensures review of relevant state and national data to inform rate amounts and payment models, with emphasis on models that promote high value services by connecting reimbursement to performance.
- Formalizes a clear and transparent process for rate determination via public notice, presentation and comments (as well as public response to comments) on proposed rates.
- Establishes a rate system sub-committee to the MaineCare Advisory Committee (MAC).
- Establishes the MaineCare Rate Reform Expert Technical Advisory Panel (TAP) for consultative purposes.