Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: The MaineCare Accountable Communities (AC) Program
NATURE OF PROPOSED CHANGES: The Department is making changes to the AC program for the Performance Year (PY) aligning with State Fiscal Year 2027 (SFY 27, July 1, 2026 – June 30, 2027). The changes below impact the methodology under which an AC may qualify for a shared savings payment or be required to repay a shared loss payment. The Department will:
- Include new initiative requirements for successful participation in Department-Aligned Initiatives which are established here https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/accountable-communities, and are effective for services on and after July 1, 2026. These include options related to Controlling High Blood Pressure and Reducing Readmissions and AC Collaboration on Member Outreach related to Eligibility.
- Update information related to AC quality measures, effective for services on and after July 1, 2026, which can be found here https://www.maine.gov/dhhs/oms/providers/value-based-purchasing.
- Clarify that crisis services are included as core services, distinct from other service types listed.
REASON FOR PROPOSED CHANGES: All changes are pursuant to Department discretion, including data analysis and review of other state and national accountable care models.
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost neutral in federal fiscal years 2026 and 2027.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926.
CONTACT INFORMATION
FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See https://www.maine.gov/dhhs/about/rulemaking for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
Off