Sections 23, 25, 30, 40, 89, 97 B & D, 102: Cost-of-Living Adjustments (COLAs) Implementation Plan

Sep 15, 2025

As previously noticed, MaineCare is increasing certain hospital reimbursement rates to reflect a 1.0% COLA.

MaineCare will implement new rates for billing when funding for this COLA is available to the Department on September 24, 2025. New rates will be effective retroactively to July 1, 2025.

Updated fee schedules will be available by September 24, 2025, on the Rate Setting page of the Health PAS Online Portal.

New rates affect eligible services under the following sections of the MaineCare Benefits Manual:

Section 23	Developmental and Behavioral Evaluation Clinic Services
Section 25	Dental Services
Section 30	Family Planning Services (select codes)
Section 40	Home Health Services
Section 89	MaineMOM Services
Section 97B	Private Non-Medical Institutions, Substance Use Treatment Facilities
Section 97D	Private Non-Medical Institutions, Children’s Residential Facilities
Section 102	Rehabilitative Services

 

Adjustment Billing Guidance for Dates of Service July 1, 2025, through September 23, 2025

Providers are responsible for adjusting all affected claims. The Department recommends adjusting claims with the oldest dates first, to avoid 120-day adjustment timely filing edits. For additional billing guidance when adjusting or reversing claims, please see the How to Adjust Claims for Retro Rate Increases (PDF) document.

Claims with Prior Authorizations (PA)

The Department recommends providers adjust claims with PAs instead of reversing and rebilling the claims to reduce the risk of PA related denials. Please first consider the number of units on the PA before you submit the adjustment.

If you prefer to reverse and rebill, please ensure the reversal processes to a “reversed” status before you submit, to allow the units to be available for the new claim and to avoid duplicate denials.  

For questions, please contact your Provider Relations Specialist.