Medicare Standardization Adjustments

Dec 27, 2022

Effective January 1, 2023, the Department is updating reimbursement rates for Medicare covered codes and services. The new reimbursement rates will apply to the services noted below, with the updated rates reflecting 72.4% of the 2023 Medicare rates. The Department will post the new rates to MIHMS as they are completed.  

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

The Department is providing this notice pursuant to P.L.2021, Ch. 639, which requires advance notice for planned Medicare fee schedule changes that do not require rulemaking. The Department provided notice in June 2022 that it was moving to a methodology of 72.4% of current year Medicare to implement Medicare Standardization. The purpose of Medicare Standardization is to move MaineCare towards using a more consistent percentage of Medicare, and to use current year Medicare rates that the Centers for Medicare & Medicaid Services updates annually. Medicare Standardization is part 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). This update incorporates 2023 Medicare rates. 

Note that these adjustments only apply to services benchmarked to Medicare under the specified Sections of Policy for eligible services above. 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).