Attention Providers of Sections 12, 18, 19, 20, 21, 29, and 96 Services: Part AAAA Long-Term Services and Supports and HCBS Rate Increases

Apr 29, 2022

Next week, the Department will update the rates for MaineCare Benefits Manual Sections 12, 18, 19, 20, 21, 29, and 96 associated with Part AAAA of P.L. 2021, ch. 398 retroactively to January 1, 2022. Please see our previous announcement for more detail on these rate increases, including a summary rate table with specific codes and rates affected by this change.

The Department will have prior authorizations (PAs) updated for sections 12, 18, 19, 20, 21, 29, and 96 services and claims will be available for provider adjustment on Wednesday, May 4, 2022, with one exception: PAs for Section 21 Home Support- Agency Per Diem (T2016 or T2016 SC), will be updated and claims will be available for adjustment on Friday, May 20, 2022. The later date for these Agency Home Support codes is due to additional system changes needed to enable retroactive billing of those rates.

We will notify you when the PA updates and full list of rates are in the MIHMS Health PAS Online Portal, and you may adjust your claims for the higher rate at that time.

The purpose of these rate adjustments is to ensure that the labor components of rates are equal to at least 125% of minimum wage, consistent with the intent of Part AAAA of the biennial budget, for numerous long-term care and home and community-based services. The rates are further calibrated to reflect actual changes in the cost of living over the past year, providing additional support for the wages of all staff providing these services and for other programmatic costs. Please see the e-message from January 31, 2022 for more information regarding these rate updates.

The Department has received approvals from the Centers for Medicare & Medicaid Services (CMS) for these rate increases.

Please contact Provider Relations Specialist, Tammy Usher with questions