Implementation of January 1, 2023, Rate Study Increases for Sections 13, 17 and 26

Jan 11, 2023

This e-message is to notify providers that updated rates are now available for billing in MIHMS for Sections 13, 17, and 26. These new rates will be effective retroactive to January 1, 2023, and result from our recent rate studies conducted in relation to P.L. 2021 Ch. 398, Pt. AAAA; Ch. 635, Pt JJJ; and Ch. 639. New rates will apply only to services provided on or after January 1, 2023. 

For Section 13, 17, and 26 services not yet billed, providers should proceed to bill using the new rates and, for Section 17 ACT services, the new unit, indicated on the fee schedules now available on the Health PAS Online Portal.  

For Section 13, 17, and 26 services already billed:  

• If the provider has already billed for these services at the new rates, for all services in these sections except for Section 17 ACT services (see below), MaineCare will adjust the claims to ensure payment at the new rates retroactive to January 1, 2023. No further provider action is needed. 

• If the provider has already billed for these services with the rates that were in effect as of December 31, 2022, the provider will need to adjust its own claims. Detailed instructions for claims adjustment can be found here. 

For Section 17 ACT services, only: 

• If the provider has already billed for ACT services at the new rates and new weekly unit, these claims denied, but MaineCare will adjust the claims to pay consistent with the new rate and unit retroactive to January 1, 2023. No further provider action is needed. 

• If the provider has already billed for ACT services with the rate and daily unit that were in effect as of December 31, 2022, the provider will need to adjust its own claims. Detailed instructions for claims adjustment can be found here. 

For more information regarding billing guidance for these sections, see the January 9, 2023, message. 

For questions regarding any of these changes or guidance, please contact your Provider Relations Specialist.