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 Program
NATURE OF PROPOSED CHANGES: The Department plans to establish a one-year transitional period for the AC program, during which the Department will not assess performance for the purposes of issuing any shared savings payments. This transition year covers the performance period from July 1, 2024 – June 30, 2025. The Department will continue to engage with AC lead entities on contractual agreements. This year enables the Department and the AC lead entities to take additional time for contracting, data analyses, vendor procurement, and analyses before advancing into a reformed program in SFY 26.
In addition, for the shared savings payments related to Performance Year 8 (August 1, 2021- July 31, 2022), anticipated this summer, the Department will be removing children’s residential treatment costs from “core services” for which ACs are accountable and removing the additional member reattribution process related to these services due to methodological issues with its application. Lastly, related to the impact of COVID-19 on the AC program methodology, the Department will continue to remove COVID-19 testing, vaccine, and treatment costs and will adjust risk scores and member months accordingly to account for the removal of these costs. The Department will also adjust our quality measure scoring and benchmarks to align with COVID-related guidance from the national measure stewards guidance regarding impacts of COVID on cross year comparisons to allow or disallow quality improvement points and transitions to same year benchmarks, as appropriate.
REASON FOR PROPOSED CHANGES: All changes are pursuant to department discretion.
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 2024 and 2025.
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. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location.
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 http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
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