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The Department initiated a Rate Determination Process* for MaineCare Benefits Manual (MBM), Section 43: Hospice Services.
Reimbursement rates are being determined pursuant to P.L. 2025, Ch. 388. Opportunities to further align Hospice Services with Medicare requirements and improve access to Hospice care will be explored during the rate determination process.
MaineCare updated the OTP (H0020) rate retroactively due to a rate update from the Centers for Medicare Services (CMS) in March 2025. This new rate was implemented for billing on December 17, 2025.
Referral Process
Beginning February 2, 2026, Single Assessment Referrals will be the required statewide process for determining eligibility for children’s medium- and high-intensity behavioral health services, under Maine’s Children’s Behavioral Health Services Settlement Agreement.
Single Assessment is a standardized approach to assessing behavioral health needs and identifying the appropriate level of care and clinically indicated services for children who require medium- to high-intensity services.
Training
Corrected for Calendar Year
Effective January 1, 2026, MaineCare will update reimbursement rates for Medicare covered codes and services for the sections of policy noted below. The new rates will reflect 72.4% of the most recent 2026 Medicare rates.
Effective January 1, 2026, MaineCare will update reimbursement rates for Medicare covered codes and services for the sections of policy noted below. The new rates will reflect 72.4% of the most recent 2026 Medicare rates.
Effective January 1, 2026, MaineCare is updating ASC rates to reflect 100% of current year Medicare rates.
Once new rates are implemented, MaineCare will provide adjustment billing guidance and post an updated fee schedule to the Rate Setting webpage of the Health PAS Online Portal.
Effective January 1, 2026, MaineCare will update ambulance service rates to reflect 100% of the most current Maine Medicare area 99 urban, rural, or super rural rates.
Effective January 1, 2026, MaineCare is updating DME rates to reflect 100% of current year Medicare rates.
Once new rates are implemented, MaineCare will provide adjustment billing guidance and post an updated fee schedule to the Rate Setting webpage of the Health PAS Online Portal.
Effective November 15, 2025, MaineCare implemented a temporary process to support member access to hearing aids when a provider determines a member is clinically eligible for a binaural hearing aid, but the member only meets MaineCare Benefits Manual (MBM), Chapter II, Section 60: Durable Medical Equipment and Section 109: Speech and Hearing Services coverage criteria for a monaural hearin
In a previous notice, the Office of MaineCare Services (OMS) reminded providers of their responsibility regarding third-party liability and secondary billing. Pursuant to MaineCare Benefits Manual (MBM) Ch. I Section 1.07-3(B), MaineCare is the payor of last resort.