​​Attention Section 45 Hospitals with Distinct Psychiatric and Substance Use Disorder (SUD) Units: Proposed Rates​

Jul 14, 2023

As a follow up to our June 16, 2023 Rate Determination Update Notice for Section 45 Hospital, Distinct Psychiatric and SUD units, please see the proposed per diem base rates in the table below. Under the new methodology, MaineCare applies Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights and Length of Stay factors to these per diem base rates to determine reimbursement for each claim. MaineCare calculated these per diem base rates to result in total reimbursement equal to one hundred percent (100%) of the costs of such discharges in the aggregate across all hospitals with distinct units, utilizing 2022 hospital cost report data, when multiplied by the Medicare MS-DRG and Length of Stay factor. 

 

Distinct Psychiatric and Substance Use Disorder (SUD) Units – Per Diem Base Rates effective July 1, 2023
MH Adult	$1,143.75
MH Child (age 18 and younger)	$893.75
SUD (Adult & Child)	$1,679.25

 

To view the proposed definitions for Distinct Psychiatric and Distinct SUD units, and for details around timing, please refer to the June 16, 2023, notice. 

The Department plans to initiate rulemaking shortly, consistent with the Maine Administrative Procedures Act (MAPA), to formally incorporate the new reimbursement methodology into Section 45. Providers will have the opportunity to provide feedback and/or comment on these changes at that time.    

Please contact Jessica Levesque, Rate Reform Project Manager for questions on this rate determination.    

*This notice is sent pursuant to Public Law 2021, Ch. 639.