Update on January 1, 2023, Rate Study Increases

Dec 30, 2022

The Maine Department of Health and Human Services (DHHS) is in the process of implementing rate studies for Sections 2, 13, 17, 26, 28, 65, and 92. Once implemented, these rate increases will be effective as of January 1, 2023. The Department has posted State Plan methodology notices detailing the rate changes for Sections 13, 17, 26, 28, 65, and 92 on our State Plan Methodology page. If a code for a service is not listed on these notices, there is no rate change for that code.

The new rates will take effect on January 1, 2023, but they will not be available to bill immediately. MaineCare will update our claims system in the coming weeks to include the codes for these services. Please hold on submitting claims under these sections until the system update is complete. We anticipate completing this process no later than mid-February for Sections 13, 17, 26, and 92, and no later than early March for Sections 28 and 65. We will send another e-message within the next two weeks providing any updates on implementation timelines for these Sections. We will also send additional messages when the system updates are complete for each Section.

In advance of the go-live dates for billing, MaineCare will issue billing guidance for services where there will be a change in billing unit or required modifiers. 

Although the rate amounts themselves are final, pending rulemaking and approval by the Centers for Medicare & Medicaid Services, MaineCare is still in the process of finalizing the rate determination documentation for these rate studies, as required under P.L. 2021 ch. 639. This documentation, including responses to public comments, will be posted on MaineCare’s Rate System Reform Website by the end of January. In determining these final rates, MaineCare reviewed and took into consideration all of the public input received, and we thank all those who contributed.

MaineCare has not yet posted rates for Section 2 services. Our rate determination process for this service remains ongoing, with a meeting to present a draft rate model scheduled for January 12, 2023. We continue to project a January 1, 2023, effective date for this service, but we do not yet have a timeframe for when the new rates will be available for billing.

As a reminder, the Department is not implementing any rate decreases at this time, even if they were recommended by Burns and Associates as a result of these rate studies. This is due to Maintenance of Effort Requirements associated with Section 9817 of the American Rescue Plan, and the directive contained within the Plan to enhance, expand, or strengthen home and community based services, including behavioral health services. The Department will hold rates recommended to get a decrease at current levels for the time being, until cost of living adjustments applied to the recommended rate would result in an overall rate increase. For example: If the current rate for a service is $10.20, and the recommended rate is $10.00, the Department will maintain the rate at $10.20. If after one year from the effective date other services in that Section of policy are to receive a 3% cost of living adjustment, the Department would increase the $10.20 rate to $10.30 (a 3% increase over the recommended $10.00 rate). The Department will reassess all recommended decreases when the Section 9817 Maintenance of Effort requirements expire on March 31, 2025.

Finally, some reimbursement changes that involve more substantial changes or new services will go live at later dates. These include the Behavioral Health Home hi-fi wraparound, as well as pay-for-performance provisions for some services. Additional detail will be forthcoming.

For questions regarding billing, please contact your Provider Relations Specialist.