MaineCare Notice of Agency Rule-making Proposal, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Below, please find a MaineCare Notice of Agency Rule-making Proposal. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.
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Notice of Agency Rule-making Proposal
AGENCY: Department of Health and Human Services, Office of MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R, Chapter 101, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
TYPE OF RULE: Routine Technical
PROPOSAL FILING NUMBER:
BRIEF SUMMARY: The Department of Health and Human Services (the Department) proposes these rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services. The Department’s principal purpose of this rulemaking is to make permanent the changes made to this policy enacted through emergency rulemaking on August 29, 2025, pursuant to Title 5, M.R.S. §8054.
- Section 45.02-8 (Days Awaiting Placement) has been expanded to include reimbursement days awaiting placement for individuals who await placement in a PNMI E (Community Residence for Persons with Mental Illness). This reimbursement is still capped at $1.5 million per state fiscal year, and includes days awaiting placement for individuals awaiting placement at nursing facilities;
- Effective retroactive to January 1, 2025, Section 45.04-1(A) and (B) are amended to reduce the reimbursement amount for inpatient and outpatient services for acute care critical access hospitals from 109% to 104.5%, as required by 22 M.R.S. Sec. 1714-D.
- P.L. 2023, ch 643, Sec. LL-1, amended 22 M.R.S. Sec. 1714-C ending critical access hospital staff enhancement payments effective December 31, 2024, Sec. 45.04-1(D), and Section 45.04-2 Supplemental Pool is deleted.
- Appendix A, 45.A-4 – Outlier Adjustment, the outlier adjustment formula in the November 6, 2024 rule is effective from July 1, 2024, through August 28, 2025. Effective August 29, 2025 there is a new outlier adjustment formula, which may result in a reduction in reimbursement for certain inpatient stays.
PUBLIC HEARING: The Department has determined that its public hearing will be hybrid, conducted both in-person and remotely, via Zoom.
Monday, September 29, 2025, 8:30 AM EST
109 Capitol Street, Augusta, Maine 04333
Maine Conference Rooms A & B
Zoom meeting link: https://mainestate.zoom.us/j/87940597033
Meeting ID: 879 4059 7033
One Tap Mobile: 1-646-931-3860
Find your local number: https://mainestate.zoom.us/u/kdGlnAICuR
Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to participate in the hearing contact the person listed for this filing 5 days in advance of the hearing.
In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.
COMMENT DEADLINE: October 9, 2025
CONTACT PERSON FOR THIS FILING:
Heather Pelletier, Social Services Program Manager
Office of MaineCare Services
11 State House Station, 109 Capitol Street
Augusta, Maine 04333-0011
TEL: (207) 287-2286 FAX: (207) 287-6106 TDD/TTY: 711