MaineCare Cost-of-Living Adjustments 

Jun 03, 2022

MaineCare is increasing reimbursement rates for certain services through a cost-of-living adjustment (COLA) as directed by Maine PL 2021, ch 635, Part A. The COLA will be equal to an increase of 4.94% above the currently established rate(s), which is equal to the percentage increase in the state minimum wage as set by the Maine Department of Labor as of January 1, 2022.   

These COLAs affect rates for eligible services under the following sections of the MaineCare Benefits Manual (MBM). Services within these Sections with an increase to their rate effective within the 12-month period previous to July 1, 2022 will not receive this COLA. Note that these COLA adjustments only apply to rates specified under these Sections of Policy for eligible services: when a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictate the reimbursement amount (e.g. reimbursement for many of the services Section 30 Family Planning providers deliver is driven by reimbursement policy under Section 90. Only those codes referenced under Section 30 would receive this COLA increase—not those under Section 90). 

COLA Rate Adjustments: MaineCare Benefits Manual Section/Title
Section 13	Targeted Case Management Services
Section 17	Community Support Services
Section 23	Developmental and Behavioral Evaluation Clinic Services
Section 28	Rehabilitative and Community Support Services for Children with Cognitive Impairments and Function Limitations
Section 30	Family Planning Services
Section 40	Home Health Services
Section 65	Behavioral Health Services
Section 91	Health Home Services - Community Care Teams
Section 92	Behavioral Health Home Services
Section 93	Opioid Health Home Services
Section 97	Private Non-Medical Institutional Services, Appendix D, Therapeutic Foster Care
Section 102	Rehabilitative Services

Medicare Standardization 

MaineCare is amending the year and percentage of Medicare that MaineCare benchmarks for reimbursement of certain services, to move toward a more consistent percentage of Medicare and to utilize current year Medicare rates that the Centers for Medicare & Medicaid Services updates annually.  These changes will be effective July 1, 2022, and are part of the process of implementing recommendations from the Department’s comprehensive rate system evaluation completed by the independent firm Myers and Stauffer, and approved by the legislature in 2021 (P.L. 398).   

Under this updated methodology, the Department will reimburse the indicated services, where Medicare provides a reimbursement rate, at the lowest of the following:  

(1) seventy-two point four percent (72.4%) of the current year’s Medicare rate per code, including appropriate Medicare fee adjustments for place-of-service modifiers in effect at the time of service; or  

(2) the provider’s usual or customary charge.   

This new methodology will apply to services benchmarked to Medicare under the following sections of the MaineCare Benefits Manual. Note that these adjustments only apply to rates and reimbursement methodology specified under these Sections of Policy for eligible services: when a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictate the reimbursement amount (e.g. reimbursement for laboratory services under Section 95, Podiatry, is dictated by reimbursement methodology and rates set forth in Section 55, Laboratory Services. Podiatry providers will continue to receive reimbursement for Laboratory services in accordance with Section 55).    

Medicare Benchmark Rate Updates: MaineCare Benefits Manual Section/Title
Section 14	Advanced Practice Registered Nursing Services
Section 15	Chiropractic Services
Section 30	Family Planning Services
Section 68	Occupational Therapy Services
Section 75	Vision Services
Section 85	Physical Therapy Services
Section 90	Physician Services (*see exception below for Enhanced Primary Care Providers)
Section 95	Podiatric Services
Section 101	Medical Imaging Services
Section 109	Speech and Hearing Services

Reimbursement for Enhanced Primary Care Provider services under Section 90, Physician Services will receive 100% of the current year Medicare rate.   

The new rates, effective July 1, 2022, are linked in the table above and are available now on the MaineCare website for all Sections above except for Sections 30 and 101. Rates for Sections 30 and 101 will be available at the corresponding links early in the week of June 6, 2022. On the website, look for the file name that includes the date of July 1, 2022.