Section 45, Hospitals: Inpatient Cost-of-Living Adjustments (COLA), & DRG Weight Update, CRs 141509, 141515, 141524

MaineCare is increasing certain Section 45, inpatient reimbursement rates through a 3.7% COLA as directed by MRS Title 22, §3173-J (referred to as ‘Rate Reform Statute’) and as funded through P.L. 2025, Ch. 650, Sec. YYY-2.  

The following reimbursement rates related to hospital inpatient services will be implemented for retroactive billing back to the following effective dates: 

Effective July 1, 2026 

  • Inpatient base rates  

  • Distinct psychiatric and distinct substance use disorder unit per diem inpatient base rates  

Effective July 23, 2026 

  • Graduate Medical Education (GME) add-on rates 

In addition, we are: 

  • Increasing the inpatient Medicare Severity Diagnosis Related Group (MS-DRG)-Based outlier payment threshold by 3.07%, retroactive to July 23, 2026. 

  • Updating the MS-DRG weights, in alignment with Medicare, effective July 1, 2026. 

MaineCare expects updated reimbursement rates to be implemented for billing by August 4, 2026. We will update you if this date needs to change. 

MaineCare will adjust all affected claims. No provider action is required.  

For questions, please contact your Provider Relations Specialist.