MaineCare Rate Setting and Reform: Did You Know?

Jun 10, 2024

The Department’s Rate Reform initiative, which was codified into law in August of 2022, with the adoption of P.L. 2021, Ch. 639 (now MRS Title 22, 3173-J), is well under way. Consistent with the Department’s goal of providing a transparent process for rate determinations with opportunities for robust participation from interested parties, the Department is sharing the following resources.   

MaineCare Rate System Reform Webpage 

On the Rate System Reform webpage you can track the Department’s progress on rate determinations and find important dates to participate. Below is a summary of the information you will find there.   

• Rate determinations that are in-progress, upcoming, or previously completed. Included under each listed rate determination are all related e-notices, presented materials, rationales, and comment summaries  

• Cost-of-Living Adjustment (COLA), and Medicare Standardization annual e-notices (since June of 2022) 

• The Comprehensive Rate System Evaluation (CRSE) that informed our Rate Reform Initiatives 

• An explanation of the Annual Rate Determination Schedule Process, including presented materials, recordings, associated notices and final schedules developed to date (2023 and 2024) 

• Past Rate System Reform related announcements 

• Flow chart that explains the typical Rate Determination Process 

• Frequently Asked Questions (FAQ’s) – Coming Soon! 

Suggestions for the next DRAFT Rate Determination Schedule, can be submitted to RateReform.OMS@Maine.gov. The Annual Rate Determination Schedule Process occurs each fall between October and December. 

Ongoing Opportunities for Feedback 

Interested parties who want to participate in the rate-setting system may join the Rate System Sub-Committee to offer their feedback and advice or to participate in discussions related to the Department’s planned and completed rate reform work. This sub-committee is open to all interested parties and meets on the 4th, or last Monday of each month from 2:00PM – 3:00PM, via Zoom. For more information on this committee and other advisory groups, please go to our MaineCare Advisory Committee page. 

Current Fee Schedules 

MaineCare posts all fee schedules on the Rate Setting page of the Health PAS online portal. Annual rate updates, as well as final rates developed through the rate determination process, are posted here under the applicable section of the MaineCare Benefits Manual (MBM). Please note: Providers should ignore the ‘modified’ date for each folder. Once the folder is opened, you will find the most recent fee schedule. Each section also has an archive folder where the previous years’ rates are listed. Individual providers’ rate letters can also be accessed on the portal with a secure trading partner account. 

More to Come 

Pursuant to MRS Title 22, §3173-J, (7.) (referred to as ‘Rate Reform Statute’), MaineCare is developing a web-based Index of rates, which will replace the current process of posting fee schedules to the Rate Setting page. While we have not yet identified a launch date, more information will be provided as this work progresses.  

For questions on these resources, please contact Amanda Lee, MaineCare’s Rate Setting Coordinator.