Update**: MaineCare Cost of Living/“Part AAAA” Adjustments
MaineCare increased reimbursement rates for certain services through a cost-of-living adjustment (COLA) as directed by 22 MRSA Section 3173-J and 22 MRSA Section 7402, as enacted by Maine P.L. 2021, ch. 398, Part AAAA. The COLA is effective as of January 1, 2024, and is equal to an increase of 2.54% above the currently established rate(s). Part AAAA requires this increase with the objective to ensure that the labor components of rates for these services continue to equal at least 125% of Maine minimum wage.
The Department will post the updated fee schedules for the Sections below that were *pending approval of appropriations to the Rate Setting page of the MaineCare Health PAS online portal as they are completed. Providers should continue to bill the 2023 rates that are currently in effect. Please do not hold claims. In response to requests for alternative means of reimbursement for this increase; Reimbursement for this increase can only be made through claims because the Department does not have federal authority to pay through other means, i.e. non-claims payments. Once new rates are implemented, providers will be responsible for adjusting claims as deemed appropriate by the provider and billing guidance will be provided at that time.
**Update: New rates for Sections that were pending appropriations will be implemented in August of 2024, retroactive to January 1, 2024.
These COLAs affect rates for eligible services under the following Sections of the MaineCare Benefits Manual (MBM):
COLA Rate Adjustments: MaineCare Benefits Manual Sections and Services |
|
Section 2* |
Adult Family Care Services |
Section 12 |
Consumer Directed Attendant |
Section 13* |
Targeted Case Management Services |
Section 17* |
Community Support Services |
Section 18 |
HCBS for Adults with Brain Injury |
Section 19 |
HCBS for the Elderly and Adults with Disabilities |
Section 20 |
HCBS for Adults with Other Related Conditions |
Section 21 |
HCBS for Members with Intellectual Disabilities or Autism Spectrum Disorder |
Section 26* |
Day Health Services |
Section 28* |
Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations |
Section 29 |
Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder |
Section 65* |
Behavioral Health Services |
Section 92* |
Behavioral Health Home Services |
Section 96 |
Private Duty Nursing and Personal Care Services |
Note: these COLA adjustments only apply to rates specified under these Sections of Policy for eligible services: when a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictates the reimbursement amount (e.g. services that are driven by reimbursement under Section 90, will not receive this COLA).
Please contact your Provider Relations Specialist for questions related to this billing guidance.
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