Date posted:
Attachment(s):
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, Office of MaineCare Services
CHAPTER NUMBER AND TITLE:
10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services: EMERGENCY RULE
ADOPTED RULE NUMBER:
Findings of Emergency:
The Maine Legislature granted the Department of Health and Human Services (the Department) authority to adopt emergency rules under 5 M.R.S. Sec. 8054, if determined necessary by the Department to implement those provisions of the Supplemental Budget Act over which the Department has subject matter jurisdiction, without the requirement that it demonstrate that immediate adoption is necessary to avoid a threat to public health, safety or general welfare. P.L. 2023, ch. 643, PART VV, Sec. VV-1. The Department has determined that it is necessary to adopt this emergency rule to implement provisions of the Supplemental Budget Act regarding hospital reimbursement set forth in PART A, Sec. A-14.
CONCISE SUMMARY:
The Department adopts these emergency rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
- Effective August 29, 2025, 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.
- Effective August 29, 2025, 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.
The Department shall submit to the Centers for Medicare & Medicaid Services, and anticipates approval, for State Plan Amendments related to these provisions.
Pursuant to 5 M.R.S §8054, this emergency rule may be effective for up to ninety (90) days. The Department intends to proceed with routine technical rulemaking to permanently adopt these rule changes.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: August 29, 2025
STATUTORY AUTHORITY: 5 M.R.S. § 8054; 22 M.R.S. §§ 42, 42(8), 1714-C, 1714-D, 3173-J; P.L. 2023, CH. 643 §§ LL-1, LL-2
AGENCY CONTACT PERSON: Catherine Coolidge, Comprehensive Health Planner II
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
EMAIL: catherine.coolidge@maine.gov
TELEPHONE: 207-624-4082 FAX: (207) 287-6106
TTY: 711 (Deaf or Hard of Hearing)
Emergency
Office: MaineCare Services
Emergency
Email: catherine.coolidge@maine.gov
Comment deadline:
Effective date:
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