Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 92, Behavioral Health Home Services
NATURE OF PROPOSED CHANGES: The Department will begin reimbursing for High-Fidelity Wrap Around Services (Wrap Around BHH Services), which are a higher intensity service than children’s BHH services. The reimbursement for this service is as follows:
|
Description |
Unit |
Rate |
|
High-Fidelity Wrap Around Services |
Per Member Per Month |
$1,887.69 |
In addition, the existing pay-for-performance provisions for child and adult members will be ending January 30, 2026, and will be replaced in the near future. The Department will issue a notice in the near future with details related to the new and upcoming pay-for-performance provisions.
REASON FOR PROPOSED CHANGES: All changes are pursuant to the DOJ Settlement Agreement, United States v. State of Maine, No. 1:24-cv-00315-SDN (D. Me. Dec. 20, 2024) (Order on Mot. Dismiss and Retain Jurisdiction, Ex. A, Settlement Agreement Between the United States of America and the State of Maine.)
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $3,822,573 in federal fiscal year 2026 which includes $2,397,886 in federal funds and $1,424,687 in state funds, and will cost $10,476,682 in federal fiscal year 2027 which includes $6,498,363 in federal funds and $3,978,319 in state funds.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926.
CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
On