Section 65 Cost-of-Living Adjustments: Rates Corrected & Implemented
Last week, MaineCare identified an error in the rate calculations for Section 65 that we implemented with an effective date of January 1, 2026.
Section 67, Nursing Facility (NF) - Quality Bonus Pool (QBP) Payments
On December 22, 2025, we emailed QBP letters to administrators and senior level leadership for NFs that met the 2025 participation criteria to earn a QBP award. Each letter included the anticipated dollar amount for each NF, as described in MaineCare Benefits Manual (MBM), Chapter III, Section 67 (22.6.3). The payment date and confirmation of final amount is contingent on approval from the Centers for Medicare & Medicaid Services. We will send an update upon federal approval and will release payments approximately two weeks after federal approval.
2025 Health Care Reviews
Below are the Certificate of Need healthcare reviews conducted during the year of 2025. You can also view reviews from previous years.
Hospital/Acute Care Reviews
MaineHealth
Integration of York Hospital into MaineHealth
MaineMOM
Care Coordination
- Screenings, assessments, and development of a care plan throughout the perinatal period
- Access to medical, behavioral, and social services
- Support during transitions like hospital discharge and re-entry form jail or prison
Medication for opioid use disorder (OUD)
- Monthly visi
Revalidate with MaineCare to Avoid Claim Denials
Per the Affordable Care Act (ACA), Section 6401, all providers need to revalidate with all states they are enrolled with.
Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidation began in January 2022.
Updated MaineCare Orthodontia Pro-Rate Request Form
Effective January 1, 2026, the MaineCare Orthodontia Pro-Rate Request Form is updated on the Manuals, Forms, and Criteria Sheets page of the Health PAS Online Portal.
This updated form reduces the administrative burden for providers and the Department when a prior authorization for Comprehensive or Limited Orthodontic treatment must be repriced because treatment stops before it is completed.
Quit Tobacco Services Preparing for January 5 Tobacco Tax Change
Jan 1, 2026
Tobacco use is the leading cause of preventable disease and death in Maine and the United States. It has major impacts on health care costs and lost productivity, affecting individuals, families, businesses, and the State.
CORRECTION to Section 65 Rates for January 1, 2026
MaineCare identified an error in the calculations for Section 65, cost-of-living adjustment (COLA) rates that were recently implemented with an effective date of January 1, 2026. The fee schedule also reflects this error.
Nursing Facility Rate Reform: One Year In, and Building Toward 2026
Jan 1, 2026
On January 1, 2025, Maine implemented a comprehensive reform of nursing facility reimbursement rates through MaineCare to stabilize a sector under strain, strengthen the direct care workforce, improve quality, and ensure continued access to care for Maine’s older adults.
One year in, the results are encouraging, and the State is moving forward with confidence into 2026.
CORRECTION to Section 67, Nursing Facility (NF) Rate Letters Published on December 31, 2025
The Department identified an error in the capital cost calculations on the NF rate letters. Revised rate letters are now available on the secure Health PAS Online Portal.