MaineCare Rate System Reform

Our Goal

To provide a clear and transparent process for MaineCare rate determinations, with opportunities for robust participation from all interested stakeholders.

Get more information on how you can participate and to view our monthly Rate System Reform updates.

We continue to update 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.

What is Rate Determination?

Rate Determination is a process conducted by the department to establish the reimbursement rate methodology, base rate amount or payment model for a MaineCare section of policy or for a specific covered service. Rate Determination is done through adoption or adaptation of a benchmark rate or methodology from another payer (e.g., private insurance, Medicare, another Medicaid agency) or developed through a rate study. Determinations may also lead to a rate study.

There are five phases in a Rate Determination: 

Phase 1   Project Kickoff

Phase 2   Provider Data   Collection

Phase 3   Rate Model   Development

Phase 4   Public   Comment

Phase 5   Finalize     Proposed Rates

Typical Rate Determination Process Flowchart (PDF)

Typical Rate Determination Proces Ordered List (PDF)

CY 2024 Rate Determinations - in Progress

Public Notices	Presented Materials and Other Documents	Other Information
65 Mobile Crisis Response Teams
Initiation 9/01/2022 Kickoff and survey overview 3/11/2022 Draft Service Model and Survey Invite 2/21/2023 Draft Service Model and Rate Forum Invite 1/2/2024	Kickoff recording - 5/12/2022 Draft Service Model Presentation (PDF) 2/24/2023 Draft Service Model and Survey Tool Recording - 2/24/2023 Draft Service Model and Rates, Public Forum HMA-Burns Presentation, DHHS Presentation, Draft Rate Models and Recording	Rationale: The American Rescue Plan Act of 2021 (ARP) amended Title XIX of the Social Security Act by adding after section 1946 (42 U.S.C. 1396w–5) the following new section: SEC. 1947. "State Option to Provide Qualifying Community-Based Mobile Crisis Intervention Services.” DHHS is reforming mobile crisis services to improve the service and align with this new federal opportunity. Services: Mobile Crisis/Resolution Effective Date: Pending Service Redesign  Next Rate Adjustment: Pending Service Redesign Further Section Change Needed: None
107 Psychiatric Residential Treatment Facility
Initiation Draft Rate Model Public Review and Comment 5/26/2023 Public Forum Presented Materials and Comment Deadline - 6/16/2023     (Please see CORRECTION to the         above notice)  Revised Draft Rates Public Review and Comment Invite - 10/22/2024       Public Review Postponed -    11/5/2024    Rescheduled Public Review -   12/6/2024	Draft Rate/Public Forum Presentation Recording - 6/15/2023 Draft Rate/Public Forum Presentation (PDF) - 6/15/2023	Rationale:  P.L. 2021, Ch. 635 Services: All Effective Date: Pending Rate Determination  Next Rate Adjustment: Pending Rate Determination Further Section Change Needed: None
45, Specific to Acute Inpatient Distinct Psychiatric & SUD Units (for medically supervised withdrawal)
Initiation 10/7/2022 Hospital Informational Forum 12/5/2022 Public Forum Presented Materials and Comment Deadline 1/26/2023 Rate Determination Update 6/16/2023 Final Draft Rates Notice - 7/14/2023	Hospital Informational Forum Presentation (PDF) 12/19/2022 Hospital Informational Forum Recording  12/19/2022 Draft Public Forum Presentation (PDF) - 1/12/2023 Draft Rate Determination Forum Recording - 1/12/2023 Comment Summary with Department Response (PDF) - 5/8/2024 Final Rates & Methodology (PDF) - 5/8/2024	Rationale: P.L. 2021, Ch. 635 Services: Inpatient Distinct Psychiatric and Substance Use Disorder Units Effective Date: July 1, 2023 Next Rate Adjustment: COLA Annually in July Further Section Change Needed: None
46, Institutions for Mental Disease (IMD)
Initiation 10/7/2022		Rationale: P.L. 2021, Ch. 635 Services: All Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: TBD
45 Hospitals
Initiation 6/23/2023 Draft Rate Model Public Forum Invite 11/29/2023 Draft Reimbursement Methods Public Forum Invite - 2/12/2024 Draft Rates & Methodologies Public Review and Comment Invite - 3/22/2024     Public Review Rescheduled - 4/2/2024     Public Review Postponed - 5/1/2024 Public Review Rescheduled - 5/31/2024 Public Forum Presented Materials & Comment Deadline - 6/13/2024	Draft Rate Methodology Public Review: Inpatient Presentation (PDF) and Recording - 12/11/2023 Draft Reimbursement Methodology Public Review: Outpatient Presentation (PDF) and Recording - 2/26/2024 Public Review and Comment: Forum Recording and PPT Presentation (PDF) - June 11, 2024 Clarifications from June 11, 2024, Public Review and Comment Forum (PDF) - 6/18/2024 Updates Following June 11, 2024, Forum (PDF) - 7/25/2024 Comment Summary with Department Responses (PDF) - 8/9/2024	Rationale: Public Commitment. Outdated reimbursement methodology, incent quality/cost effectiveness Services: All Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: TBD
30 Family Planning (New Alternative Payment Model)
Initiation 11/17/2022 Kickoff 1/26/2023 Public Forum 10/20/2023 Presented Materials and Comment Deadline  11/28/2023	Kickoff Meeting Presentation (PDF) - 1/26/2023 Kickoff Meeting Recording - 1/26/2023 APM Draft Rate & Service Model Public Review & Comment Version 2 (PDF) & (Corrected) Version 3 (PDF) & Recording - 11/20/2023	Rationale: Public Commitment. Current reimbursement does not reflect team-based, patient centered approach to integrated care Services: All Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: None
67, 97 C - Nursing Homes and Private Non-Medical Institutions - Appendix C Residential Care
Initiation 1/12/2023 Kickoff 2/1/2023 Provider Rate Method Workgroup #1 Presented Materials Notice 3/28/2023 Provider Rate Method Workgroup #2 Presented Materials Notice 4/24/2023 Provider Rate Method Workgroup #3 Presented Materials Notice - 5/22/2023 Provider Rate Method Workgroup #4 Presented Materials Notice - 6/9/2023 Provider Rate Method Workgroup #5 Presented Materials Notice - 6/30/2023 Draft Rate Methodology Public Review and Comment for NF's - 2/23/2024 Comment Deadline Extended - 3/25/2024 Comment Deadline Extended - 4/17/2024 Revised Draft Rates and Methodologies Invite - 10/9/2024 Revised Draft Rates and Methodologies Comment Deadline & Presented Materials Notice - 10/24/2024	Kickoff Meeting Presentation (PDF) and Recording - 2/1/2023 Interested Parties Rates Workgroup Meetings: Rates Workgroup Meeting #1 Introduction & Rate Discussion Presentation (PDF) and Recording – 3/13/2023 Rates Workgroup Meeting #2 Direct/Indirect & Capital Costs Presentation (PDF) and Recording - 4/12/2023 Rates Workgroup Meeting #3 Trend Discussion Presentation (PDF) and Recording - 5/17/2023 Rates Workgroup Meeting #4 Risk Adjustment Discussion Presentation (PDF) and Recording - 6/5/2023 Rates Workgroup Meeting #5 VBP and APM Discussion Presentation (PDF) and Recording - 6/26/2023 Draft Rate Methodology Public Review and Comment for Section 67, Nursing Facilities Part I, Presentation and Recording - 3/7/2024 Draft Rate Methodology Public Review & Comment for Section 67 Nursing Facilities Part II, Presentation and Recording - 3/8/2024 Questions & Answers on Draft Rate Model - 4/5/2024 Comments & Department Responses Following March 2024 Forums (PDF) - 10/30/2024 Revised Draft Rate Methodology (PPT) - 10/23/2024 November 2024 Updates to March 2024 Comments (PDF) - 11/27/2024	Rationale: Public Commitment. Cost settlement system is administratively burdensome and does not incent quality of care or reward cost effectiveness. Services: All Effective Date: TBD, pending rate determination Next Rate Adjustment: COLA. Annually in July Pending Rate Determination Further Section Change Needed: None
97 - Appendix D Private Non-Medical Institution (Specific to Children’s Therapeutic Foster Care)
Initiation - 6/9/2023 Draft Rate Model, Public Comment - 11/17/2023 Draft Rate Model Presented Materials & Comment Deadline - 12/8/2023 Comment Deadline Extended - 12/22/2023 Final Draft Rates and Comment Summary with Department Response - 10/21/2024	Draft Rate Model Public Review & Comment (PPT) and Recording - 12/6/2023 Comment Summary (PDF) and Final Draft Rates	Rationale: Address U.S. Dept. of Justice June 2022 findings that state there is a lack of support for foster parents and address barriers to access children’s behavioral health needs in the community and be less reliant on residential facilities/institutions Services: Therapeutic Foster Care Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: TBD, pending rate determination
Demonstration - Certified Community Behavioral Health Clinics (CCBHC)
Initiation - 6/20/2023 Kickoff - 9/11/2023 Prospective Payment System Cost Report Training Session Presented Materials - 11/6/2023 Deadline for Cost Report Submissions Extended to December 15, 2023 - 11/17/2023 CCBHC Certification Documentation Due September 6, 2024 - 8/16/2024 Public Review and Comment Invite - 10/15/2024	Kickoff Meeting Recording - 9/25/2023 Kickoff Meeting Presentation (PDF) - 9/25/2023 Prospective Payment System Cost Report Training Session: Recording and Presentation (PDF)- 10/31/23 Draft Rate Methodology Public Review, Recording and Presentation (PDF)	Rationale: Department goal to increase access to high-quality, comprehensive behavioral health services Services: Behavioral Health  Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: TBD, pending rate determination
18, 20, 21, 29, HCBS for Individuals with Intellectual & Developmental Disabilities or Autism & Proposed Lifespan Waiver
Initiation and Kickoff Notice - 9/8/2023 Amendment to Inititation and Kickoff Presented Materials Notice - 9/26/2023 Cost Survey Tool 12/15/2023 Deadline Extended: Cost Survey Tool - 12/26/2023	Kickoff Meeting Presentation (PDF) - 9/15/2023 Kickoff Meeting Recording - 9/15/2023	Rationale: P.L. 2023, Ch.412, Part LLLLL. Authorizes the new Lifespan program and directs the Department to facilitate federal approval of the new program and adopt rules implementing it. Because many Lifespan services will be similar to current Section 21 and Section 29 services, development of Lifespan rates requires existing Sections 18, 20, 21 and 29 rates to be reviewed. Services: Lifespan, HCBS and Support services for Members with Intellectual Disabilities or Autism Spectrum Disorder   Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: TBD, pending rate determination
TBD - Palliative Care
Initiation - 10/13/2023 Kickoff - 3/11/2024	Kickoff Meeting Presentation and Recording - 3/27/2024	Rationale: LD/BI (LD 1064, 9817 HCBS plan)  Services: New Section/Service Effective Date: TBD Next Rate Adjustment: TBD, pending rate determination Further Section Change Needed: TBD, pending rate determination
25 - Dental (Benchmark Assessment)
Initiation - 10/13/2023 Kickoff - 10/26/2023 Benchmark Results and Draft Rates: Public Review & Comment - 3/14/2024 Public Review Rescheduled - 3/26/2024 Public Review Presented Materials and Comment Deadline - 4/16/2024 Comment Deadline Extended - 4/23/2024 Benchmark Assessment Results and Comment Summary - 7/19/2024	Kickoff Presentation (PDF) and Recording - 11/29/2023 Benchmarking Results and Draft Rates, Forum Recording and Presentation (PPT) - 4/12/2024 Comment Summary (PDF) - July 9, 2024	Rationale: Public Law Ch.639 requirement for services benchmarked to alternate payor source, update rates to most current year every 2 years Services: All Effective Date: 7/1/2024 Next Rate Adjustment: 7/1/2024 (Assessment of Benchmarks). COLA, Biennially in July
Ch. VI, Section 3 Primary Care Plus (PCPlus)
Initiation - 12/4/2023		Rationale: Establish a more advanced alternative payment model for primary care services and supports, including the incorporation of Community Health Worker (CHW) team members and social risk adjustment Services: All Effective Date: TBD Next Rate Adjustment: TBD, Pending Rate Determination
93 - Opioid Health Home, Includes New Model for Other SUDs
Initiation - 11/8/2023 Kickoff Meeting Invite - 4/23/2024	Kickoff Presentation (PDF) and Recording - 5/7/2024	Rationale: P.L. 2021, Ch. 635, Part JJJ Services: All Effective Date: TBD Next Rate Adjustment: TBD, Pending Rate Determination
TBD - Community Paramedicine (New Service)
Initiation - 11/8/2023		Rationale: MaineCare coverage for community paramedicine services to improve health outcomes, improve access to care, and reduce unavoidable costs, especially for rural residents Services: New Service (tentatively planned to be incorporated into Section 5 of the MaineCare Benefits Manual) Effective Date: TBD Next Rate Adjustment: TBD, Pending Rate Determination
14, 30, 31, 45, 90, 103, Certain Medicare Covered Family Planning Services & Long-Acting Reversible Contraception (LARCs)
Initiation - 5/28/2024 Draft Rates Public Review & Comment Invite - 9/16/2024 Draft Rate Public Review and Comment Presented Materials and Comment Deadline - 9/30/2024	Draft Rates Public Review & Comment Presentation (PDF) and Recording -9/30/2024 There is no comment summary, as no written comments were submitted.	Rationale: The Department is conducting this rate determination to maintain member access to Family Planning Services.  Services: Certain Medicare Covered Family Planning Services and Long-Acting Reversible Contraception (LARCs) Effective Date: TBD Next Rate Adjustment: TBD
12, 18, 19, 20, 21, 29, 40, 96, and 102, Home & Community Based Services (HCBS) Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology and Personal Support Services
Initiation - 6/4/2024 Amendment to Initiation Notice - 8/8/2024 Kickoff Meeting Invite - 8/5/2024 Kickoff Presented Materials Notice with Registration Links to Upcoming Engagement Sessions - 8/30/2024 Engagement Sessions Presented Materials Notices: Assistive Technology Care Coordination  Clinical Nursing  Clinical Therapy Supportive Skills Building Therapeutic Intervention Personal Support Rehabilitative Engagement Sessions, Questions & Answers Notice - 9/30/2024  Survey Notice - 10/22/2024	Code and Service Category List (PDF) Kickoff Meeting Recording and Presentation (PDF) - 8/28/2024 Interested Parties Engagement Series:  Assistive Technology Devices & Services: September 4, 2024, 11AM - 12PM EST Recording and Presentation (PDF) Care Coordination: September 6, 2024, 9AM - 10AM EST               Recording and Presentation (PDF) Clinical Nursing Services: September 11, 2024, 11AM - 12PM EST Recording and Presentation (PDF) Clinical Therapy Services: September 13, 2024, 9:30AM - 10:30AM EST Recording and Presentation (PDF) Supportive Skill Building: September 25, 2024, 11AM - 12PM EST Recording and Presentation (PDF) Therapeutic Interventions: September 27, 2024, 9:30AM - 10:30AM EST Recording and Presentation (PDF) Personal Support Services: October 7, 2024, 3PM - 4PM EST Recording and Presentation (PDF) Rehabilitative Services: October 9, 2024, 10:30AM - 11:30AM EST Recording and Presentation (PDF) Engagement Series Questions & Answers (PDF) - Updated 10/29/20024 Survey Training Recording - 10/22/2024	Rationale: Align rates of similar services across sections and Department goal to address severe state labor shortages for nurses which has contributed to a decline in utilization of services, despite increased need.  Services: Clinical, Therapy, Care Coordination, Supportive Skills Building, Assistive Technology, and Personal Support Services.  Effective Date: TBD Next Rate Adjustment: TBD
80 Pharmacy (Specific to Pharmacy Dispensing Fees)
Initiation - 12/2/2024		Rationale: Per CMS rule, Medicaid agencies must update the dispensing fees to reflect the pharmacist's professional services and costs of dispensing drugs.  Services: Pharmacy Dispensing Fees Effective Date: TBD Next Rate Adjustment: TBD
Ch. I, Section 1, Interpreter Services
Initiation - 12/16/2024		Rationale: With Maine's growing population and expansion of MaineCare, a review is necessary to ensure quality of care and to ensure access to this critical service, especially during times of trauma and urgency. Services: Interpreter Services Effective Date: TBD Next Rate Adjustment: TBD

CY 2024 Rate Determinations - Upcoming

Section of Policy	Status	Other Information
Section TBD, Coordinated Specialty Care	Internal Planning	Rationale: P.L. 2021, Ch. 398, Part A, provides funding to implement a coordinated specialty care model, to treat MaineCare members for a first episode of psychosis.  Services:
Section 106, School-Based Health Center Services & 65, Multi-Dimensional Family Therapy (MDFT)	Internal Planning	Rationale: P.L. 2021, Ch. 227, to address health-related services that are required for children ages 0-5 years, to access their education. This must be a major substantive rule. Additionally, the Children's Behavioral Health Services plan calls for MDFT services to be implemented under section 65. Finally, P.L. 2023, Ch. 412, Part A, provides funding for implementation.  Services:

Prior Rate Reform Actions To Date

Public Notices	Presented Materials and Other Documents	Other Information
Section 23, Developmental and Behavioral Clinic Services - Child Abuse Evaluations
Initiation and Public Forum Invite - 5/13/2024 Comment Deadline - 5/17/2024	Draft Rate Public Forum Draft Rate Model (PDF) and Recording - 5/17/2024 Comment Summary with Department Response (PDF) and Final Draft Rate (PDF) - 5/30/2024	Rationale: The Department is conducting this rate determination to improve member access to this service.  Services: Child Abuse Evaluation Service  Effective Date: Pending rulemaking Next Rate Adjustment: Pending rulemaking Further Section Change Needed:
Section 23, Developmental and Behavioral Clinic Services, New Service - Foster Care Comprehensive Assessments
Initiation 10/14/2022 Draft Rate, public comment  11/23/2022 Draft Rates Posted and Comment Deadline 12/2/2022 Final Draft Rates and Comment Summary  1/11/2024	Foster Care Comprehensive Health Assessment Forum Presentation (PDF) 11/30/2022 Section 23 Forum Recording 11/30/2022 Final Draft Rate Model (PDF) 1/11/2024 Comment Summary 1/11/2024	Rationale: New service to conform with 22 MRSA Section 4063-A (3) requirement that the comprehensive assessment at the time a child enters state custody be reimbursed under MaineCare Services: Foster Care Comprehensive Health Assessment  Effective Date: Pending rulemaking Next Rate Adjustment: Pending rulemaking Further Section Change Needed: Other services in Section will need review.
Section 71, National Diabetes Prevention Program
Initiation 12/16/2022 Draft Rate/Public Comment Invite - 12/29/2022 Posting of Final Draft Rate and Comment Summary 4/28/2023 UPDATED Proposed Rates - 9/1/2023 Notice of Agency Rulemaking Adoption 11/8/2023	Draft Rate/Public Comment (PDF) - 2/6/2023 Draft Rate/Public Comment Recording - 2/6/2023 Comment Summary with Department Response (PDF) - 4/25/2023 Final Draft Rates (PDF) - 4/25/2023	Rationale: P.L. 2021, Ch. 398, Sec. A-17 Services: All Effective Date: November 8, 2023 Next Rate Adjustment: In coordination with Medicare Further Section Change Needed: None
Section 2, Adult Family Care Homes
Initiation 8/11/2022 Kickoff and survey overview (direct email) 8/11/2022 Survey results (direct email) 10/24/2022 Draft Rate Public Review and Comment 11/22/2022 Comment Summary with Department Response and Final Draft Rates 4/18/2023 Implementation of January 1, 2023 Rate Study Increases 4/20/2023	Kickoff Recording & Presentation (PDF) - 8/31/2022 Survey Results (PDF) - 10/22/2022 Draft Rate/Public Comment Recording - and Presentation (PDF) - 1/12/2023 Comment Summary (PDF) - 4/14/2023 Final Draft Rate Model (PDF) - 4/14/2023	Rationale: P.L. 2021 Ch.398, Part AAAA Services: All Effective Date: 1/1/2023 implementation of AAAA rate Next Rate Adjustment:  COLA Annually in January Further Section Change Needed: None
Section 13, Targeted Case Management
Initiation 9/01/2022 Kickoff and survey overview 3/11/2022 Survey distributed 4/22/2022 Draft Rate, public comment 9/01/2022 Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022 Final Draft Rates Posted - December 30, 2022	Kickoff Recording (included all BH sections) - May, 2022 Survey Results (PDF) - 10/5/2022 9/20/2022: Draft Rate Models (PDF) Draft Rate/Public Comment Recording Draft Rate/Public Comment Presentation (PDF) Comment Summary with Department Response (PDF) - 5/22/2023 Final Rate Model (PDF) - 5/22/2023	Rationale: Department priority (appropriation in P.L. 2021, Ch. 635) Services: All Effective Date: 1/1/2023 Next Rate Adjustment: COLA Annually in January Further Section Change Needed: None
Section 17, Community Support
Initiation 9/1/2022 Kickoff and survey overview 3/11/2022 Survey distributed 4/22/2022 Draft Rate,public comment invite 9/1/2022 Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022 Final Draft Rates Posted - December 30, 2022	Kickoff Recording (included all BH sections) - May, 2022 Survey Results (PDF) - 10/5/2022 (13, 17, & 92) 9/20/2022: Draft Rate Models (PDF) Draft Rate/Public Comment Recording Draft Rate/Public Comment Presentation (PDF) (17, 28 & 65 Community-Based MH & SUD) 9/23/2022: Draft Rate/Public Comment Recording Draft Rate/Public Comment Presentation (PDF) Draft Rate Models (PDF) Comment Summary with Department Response (PDF) - 5/22/2023 Final Rate Model (PDF) - 5/22/2023	Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635 Services: All Effective Date: 1/1/2023 Next Rate Adjustment: COLA Annually in January Further Section Change Needed: None
Section 26, Day Health Services
Initiation 8/11/2022 Kickoff and survey overview (direct email) 8/11/2022 Survey results (direct email) 10/24/2022 Draft Rate Public Review and Comment 11/2/2022 Comment Summary with Department Response 4/3/2023	Kickoff Recording and Presentation (PDF) - 8/31/2022 Survey Results (PDF) - 10/24/2022 Draft Rate/Public Comment Recording and Presentation (PDF) - 11/17/2022 Comment Summary - 3/16/2023 Final Draft Rates - 12/27/2022	Rationale: P.L. 2021 Ch.398, Part AAAA Services: All Effective Date: 1/1/2023 Next Rate Adjustment: COLA Annually in January Further Section Change Needed: None
Section 28,
Initiation 9/01/2022 Kickoff and survey overview 3/11/2022 Survey distributed 4/22/2022 Draft Rate, public comment 9/01/2022 Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022 Final Draft Rates Posted - December 30, 2022	Kickoff Recording (included all BH sections) - May, 2022 Survey Results (PDF) - 10/5/2022 17, 28 & 65 Community-Based MH & SUD 9/23/2022: Draft Rate/Public Comment Recording Draft Rate/Public Comment Presentation (PDF) Draft Rate Models (PDF) Comment Summary with Department Response (PDF) - 5/22/2023 Final Rate Model (PDF) - 5/22/2023	Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635 Services: All Effective Date: 1/1/2023 Next Rate Adjustment: COLA Annually in January Further Section Change Needed: None
Section 60 DME (Phase I)
Initiation - 9/27/2022 Draft Rate, public comment - 11/22/2022 Draft fee schedule and methodology - 11/23/2022 Summary of Comments with Department Response - 2/06/2023 Billing Guidance and Corrections - 3/23/2023	Public Forum Presentation (PDF) 12/01/2022 Public Forum Recording 12/01/2022 Draft Rate Methodology (PDF) 12/01/2022 Draft Fee Schedule (PDF) 12/01/2022 Rate Forum Comments and Responses (PDF) 2/6/2023 Final Draft Fee Schedule (1/5/2023)	Rationale: Department priority (appropriation in P.L. 2021, Ch. 635) Services: 100% of Medicare, rural/non-rural, and DME index COLA for non Medicare Effective Date: 1/1/2023 Next Rate Adjustment: annually, in coordination with Medicare. Further Section Change Needed: Non-Medicare covered codes
Section 65, Behavioral Health
Initiation 9/01/2022 Kickoff and survey overview 3/11/2022 Survey distributed 4/22/2022 Draft rate, public comment 9/01/2022 Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022 Final Draft Rates Posted - December 30, 2022	Kickoff Recording (included all BH sections) - May, 2022 Survey Results (PDF) - 10/5/2022 65 Adult and Children Outpatient & School Health Related Services 9/21/2022: Draft Rate Models (PDF) Draft Rate/Public Comment Presentation (PDF) Draft Rate/Public Comment Recording 17, 28 & 65 Community Based Mental Health & SUD Services 9/23/2022: Draft Rate Models (PDF) Draft Rate/Public Comment Presentation (PDF) Draft Rate/Public Comment Recording Comment Summary with Department Response (PDF) - 5/22/2023 Final Rate Model (PDF) - 5/22/2023	Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635 Services: All Effective Date: 1/1/2023 Next Rate Adjustment: COLA Annually in January Further Section Change Needed: None
Section 65, Crisis Residential and Resolution
Initiation 9/01/2022 Kickoff and survey overview 3/11/2022 Survey distributed 4/22/2022 Draft rate public review, written comment 11/16/2022 Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022 Final Draft Rates Posted - December 30, 2022	Kickoff Recording (included all BH sections) - May, 2022 Crisis Survey Analysis 11/7/2022 Draft Rate Model (PDF) - 11/22/2022 Draft Rate Public Review Recording - 11/22/2022 Comment Summary with Department Response (PDF) - 5/22/2023 Final Rate Model - 5/22/2023	Rationale: P.L. 2021, Ch. 398, Part AAAA; P.L. 2021, Ch. 635 Services: Crisis Services Effective Date: Crisis Residential only 1/1/2023 Next Rate Adjustment: TBD Further Section Change Needed: Work on Crisis Resolution is ongoing into 2023
Section 92, Behavioral Health Homes
Initiation 9/01/2022 Kickoff and survey overview 3/11/2022 Survey Distributed 4/22/2022 Draft Rate, public comment 9/01/2022 Draft Rate Presentation Posted and Comment Deadline Reminder - September 27, 2022 Final Draft Rates Posted - December 30, 2022	Kickoff Recording (included all BH sections) - May, 2022 Survey Results (PDF) - 10/5/2022 (13, 17, & 92) 9/20/2022: Draft Rate Models (PDF) Draft Rate/Public Comment Recording Draft Rate/Public Comment Presentation (PDF) Comment Summary with Department Response (PDF) - 5/22/2023 Final Rate Model (PDF) - 5/22/2023	Rationale: Ensure equitable rates across behavioral health sections and help address DOJ findings. Services: All Effective Date: 1/1/2023 Next Rate Adjustment: COLA Annually in January Further Section Change Needed: None
31 Federally Qualified Health Centers (Rebasing)
Initiation 9/27/2022 Provider Kickoff (direct invite to MPCA) 10/17/22 Draft Rates/Public Comment Invite 3/27/2023 Billing Guidance & Implementation Timing for Updated Payment Methodology 5/01/2023 Implementation of 3/01/2023 rates 5/12/2023	Kickoff Meeting Recording - 10/17/2022 LD 1787 Presentation (PDF) - 1/18/ 2023 LD 1787 Meeting Recording - 1/18/2023 Stakeholder Infomational Recording - 2/1/2023 Stakeholder Informational Presentation (PDF) - 2/1/2023 Stakeholder Informational Recording - 2/21/2023 Draft Public Forum Presentation (PDF) - 3/30/2023 Draft Public Forum Presentation Recording - 3/30/2023 Comment Summary with Department Response (PDF) - April 23, 2024	Rationale: P.L. 2021 Ch. 747 Services: All Effective Date: 3/1/2023 Next Rate Adjustment: Annually in July Further Section Change Needed: None
Section 5 Ambulance Services
Ambulance Reimbursement Effective 4/1/2022 and Billing Guidance 3/16/2022	(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)	Rationale: Legislation, 2021 Resolve, Ch. 118 Resolve to provide add on payments for ambulance services reimbursed by MaineCare. Services: Medicare Covered Services Effective Date: 4/01/2022 Next Rate Adjustment:  Updated annually in January in Coordination with Medicare Further Section Change Needed: Non-Medicare Codes/Services
Sections 13, 17, 23, 28, 30, 40, 65, 91, 92, 93, 97-App D Therapeutic Foster Care, 102
MaineCare Cost of Living Adjustments and Medicare Standardization Effective July 1, 2022 – 6/03/2022	(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)	Rationale: Legislation, PL. 2021, Ch 635, Part A. Services: COLA Rate Adjustments (4.94% equal to the percentage increase in the state minimum wage for January 1, 2022) Effective Date: July 1, 2022 Next Rate Adjustment: Annual COLA in January (sections 13, 17, 28, 65, 92.) Annual COLA in July (sections 23, 30, 40, 91, 93, 97 B&D & 102) Further Section Change Needed: All behavioral health sections have been addressed in a recently closed 2022 Rate Study. Other sections are currently in progress or upcoming for rate determinations in CY 2023 (except for section 91 Health Home Services).
Sections 14, 15, 68, 75, 85, 90, 95, 101, 109
MaineCare Cost of Living Adjustments and Medicare Standardization Effective July 1, 2022 – 6/03/2022	(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)	Rationale: Comprehensive Rate Study Evaluation: areas of greatest need, Inconsistent, inequitable reimbursement across sections, and Standardized percentage of Medicare (72.4%) and use of current year’s rates Services: Medicare covered services Effective Date: July 1, 2022 Next Rate Adjustment: Annually in January in Coordination with Medicare Further Section Change Needed: Non-Medicare codes need to be addressed
Section 25, Dental
Notice of Dental Rate Reform Notice of Dental Policy Forum	Draft Dental Reform Methodology (PDF) Draft Dental Rates (PDF) Dental Provider Forum Presentation (PDF) Dental Rate Forum Presentation (PDF) and Recording   Dental Policy Forum Presentation (PDF) and Recording	Rationale: Comprehensive Rate Study Evaluation: areas of greatest need Services: Comprehensive adult and children’s dental Effective Date: July 1,2022 Next Rate Adjustment: July: benchmark assessment biennially. COLA (biennially).   Further Section Change Needed: None needed. Benchmarks will be assessed biennially.
Section 67, Nursing Facility Services
NF/RCF Rate Letters and 125% Minimum Wage Adjustments - 6/30/2022	(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)	Rationale: Legislation: Section AAAA-5, 2021 P.L. Ch. 398 Services: 125% min wage adjustment Effective Date: July 1, 2022 Next Rate Adjustment: Annually in January (AAAA adjustment), Annually in July, (COLA) Further Section Change Needed: Upcoming Rate Study to address the current administratively burdensome cost settlement system and to address lack of incentive for quality of care and to reward cost effectiveness.
Section 97, Appendix C, Medical Remedial (RCF)
NF/RCF Rate Letters and 125% Minimum Wage Adjustments6/30/2022	(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)	Rationale: Legislation Services: RCF 125% min wage adjustment Effective Date: July 1, 2022 Next Rate Adjustment: January 1, 2023 (AAAA adjustment-not inflation) Further Section Change Needed: Upcoming Rate Study to address the current administratively burdensome cost settlement system and to address lack of incentive for quality of care and to reward cost effectiveness.
Section 97, Appendix B, Substance Use Disorder Residential Services
PNMI B Final Draft Rates Notice - 8/27/2021	This update occurred prior to P.L. 2022 Ch. 639 becoming effective) Survey Analysis (PDF) Cost Report Analysis (PDF) Proposed Rate Models (PDF) Response to Comments (PDF) Final Rate Models (PDF)	Rationale: 1115 Demonstration Waiver (Maine's Substance Use Disorder Care Initiative) Services: All Effective Date: November 1, 2021 Next Rate Adjustment: Annual COLA in July Further Section Change Needed: none
Section 97, Appendix D, Children's Residential Care Facility
PNMI D Proposed Changes and Final Draft Rate Notice 8/13/2021	(This update occurred prior to P.L. 2022 Ch. 639 becoming effective)   Survey Analysis (PDF) - 3/03/2021 Cost Report Analysis (PDF) - 3/03/2021 Response to Public Comments (PDF) - 8/06/2021 Final Rate Models (PDF) - 8/06/2021	Rationale: Outdated legacy rate models and new federal quality standards Services: Residential Care Effective Date: November 1, 2021 Next Rate Adjustment: Annual COLA in July Further Section Change Needed: Therapeutic Foster Care. (Planned study 2023)
Section 89, MaineMOM (New Service)
Informational Session on Proposed MaineMOM Services and Reimbursement 3/18/2022	(This service developed prior to P.L. 2022 Ch. 639 becoming effective) MaineMOM Advisory Group Presentation (PDF) 9/15/2020	Rationale: New service Services: Integrated opioid tx and perinatal care for pregnant/ postpartum people/ their infants Effective Date: Rulemaking in progress Next Rate Adjustment: To Be Determined Further Section Change Needed: None needed

Cost-of-Living Adjustments (COLA) and Medicare Standardization

A schedule of COLA/Medicare Standardization updates per section of policy is coming soon!

• May 2024, COLA E-Message
• January 2024 Medicare Standardization E-Message
• January 2024, COLA E-Message
• May 2023, COLA E-Message 
• January 2023 Medicare Standardization E-Message
• January 2023 COLA E-Message
• June 2022 COLA and Medicare Standardization E-Message

Background

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.

Evaluation

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:

1. Sets a schedule for regular rate review and adjustment.
2. Establishes the MaineCare Rate Reform Expert Technical Advisory Panel (TAP) for consultative purposes.
3. Establishes a rate system sub-committee to the MaineCare Advisory Committee (MAC).
4. 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.
5. 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.

Annual Rate Determination Schedule Process

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 then posts the final rate determination schedule. 

Annual Rate Determination Schedules: Presented Materials and Associated Notices

Interested parties are encouraged to review presented materials for additional context and rationale pertaining to the proposed schedule.

CY 2024

• TAP Consultation and Public Stakeholder Forum on Draft Rate Determination Schedule E-Message
• Video of (TAP) Consultation - October 4, 2023
• TAP Consultation (PDF) 
• Proposed Annual Rate Determination Schedule (PDF)
• Public and Written Comment Summary (PDF)
• Final Rate Determination Schedule CY24 (PDF)
  • Letter from OMS Director Michelle Probert (PDF)
  • E-Message - December 8, 2023

CY 2023

• TAP Meeting and Public Stakeholder Forum on Draft Rate Determination Schedule E-Message
• Video of (TAP) Consultation - October 13,2022
• TAP Consultation (PDF)
• Proposed Annual Rate Determination Schedule (PDF)
  • E-Message - October 22, 2022
• Video of Public Forum or Interested Parties to Comment on Proposed Schedule - October 26, 2022
• Public Forum Presentation (PDF)
• Public and Written Comment Summary (PDF)
  • E-Message - November 23, 2022
• Final Rate Determination Schedule CY 2023 (PDF)
  • E-Message - December 9, 2022
  • Letter from OMS Director Michelle Probert (PDF)

Past Announcements

• Rate System Timeline and Deliverables (PDF) - November 24, 2020
• Rate System Evaluation Update (PDF) - August 27, 2020 
• Rate System Evaluation Announcement - January 21, 2020
• MaineCare Rate System Evaluation

Frequently Asked Questions (FAQs)

Sections 17, 28, and 65 Rate Adjustment FAQ (PDF) - Updated February 8, 2024

Service Provider Tax Repeal Affected Code List (PDF)

Service Provider Tax Repeal FAQs (PDF)