MaineCare Notice of Agency Rule-making Adoption, Chapter III, Section 45, Principles of Reimbursement for Hospital Services

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.

Below, please find a MaineCare Notice of Agency Rule-making Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.

__________________________________________________________________________

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

ADOPTED RULE NUMBER:

CONCISE SUMMARY:

The Department adopts this rule to amend 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services. The Department’s principal purpose of this rulemaking is to make permanent the changes made to this regulation enacted through emergency rulemaking on August 29, 2025, pursuant to Title 5, M.R.S. §8054.

  • Effective Augusts 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.
  • 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.

See http://www.maine.gov/dhhs/oms/rules/index.shtml  for rules and related rulemaking documents.

EFFECTIVE DATE:                              November 23, 2025

STATUTORY AUTHORITY: 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:           Heather Pelletier, Social Services Program Manager

AGENCY NAME:                                  Office of MaineCare Services

ADDRESS:                                             109 Capitol Street, 11 State House Station

                                                                Augusta, Maine 04333-0011

EMAIL:                                                  heather.pelletier@maine.gov

TELEPHONE:                                       207-624-4082 FAX: (207) 287-6106

                                                               TTY: 711 (Deaf or Hard of Hearing)