Section 67, Nursing Facility (NF) Reform - Phase II Specialty Care for Individuals with Acquired Brain Injury or Medical-Psychiatric Needs: Draft Rate Model Public Review & Comment and Phase I Value-Based Purchasing (VBP) Updates

Public Review & Comment

On September 3, 2025, at 9:00 AM, the Department with our vendor, Guidehouse Inc. will host a public forum, to present the recommended draft rates and rate models in addition to rationale for NF Specialty Units under Section 67 of the MaineCare Benefits Manual. Following the forum, interested parties will have the opportunity to provide public comments.

At this forum, the Department will also provide an update on Phase I of NF rate reform as it relates to the VBP requirements.

Section 3, Primary Care Plus (PCPlus) – Rate Determination Kickoff Meeting & Model Advancement Overview Presented Materials

On August 4, 2025, MaineCare held a kickoff meeting for interested parties and existing PCPlus providers to receive feedback on their experiences and insights and to introduce the next phase of PCPlus reform work. On August 11, 2025, MaineCare with our vendor Manatt Health Strategies, hosted another meeting to provide an overview of the PCPlus model and the findings of the MaineCare Primary Care Services Utilization and Spending Analysis.

Presented Materials

Transforming Maternal Health (TMaH) Model

The Maine Department of Health and Human Services (DHHS), Office of MaineCare Services was selected as one of 15 state Medicaid programs to participate in the Transforming Maternal Health (TMaH) Model. TMaH is an initiative led by the Centers for Medicare & Medicaid Services (CMS). Under TMaH, CMS has awarded DHHS nearly $17 million to improve maternal and newborn health outcomes for Maine people, to be administered over 10 years.

Maine DHHS Alerts EBT Cardholders to Take Precautions Amid Reported Multi-State Benefit Theft

See update below the post

AUGUSTA-- The Maine Department of Health and Human Services (DHHS) is alerting EBT cardholders of the reported theft of Supplemental Nutrition Assistance Program (SNAP) benefits this week. So far, this has impacted approximately 300 Maine households, stealing approximately $76,000. This incident is still unfolding, and the number of households affected may increase.

10-148 C.M.R. Ch. 6; Child Care Affordability Program Rules

The Child Care Affordability Program (CCAP) is funded by the State of Maine and the United States. This routine technical rulemaking is necessary to comply with updates to the federal rules governing the block grant that funds CCAP at  45  C.F.R. Pt. 98, which require multiple changes to the payment structure of the Child Care Affordability Program, including:

CORRECTION: Apply to Present at MaineCare’s Delivery System Reform (DSR) Annual Forum

Please note: Links in the forum attendees section are now updated.

Presenters needed for the Forum Dates & Locations:

  • Wednesday, November 5, 2025, in Presque Isle, ME
  • Thursday, November 13, 2025, in Brewer, ME
  • Tuesday, November 18, 2025, in Portland, ME

MaineCare is once again inviting you to submit presentation proposals this year!

Retro Physician Drug Rate Updates: Effective July 2024 – June 2025, CR 133663

The Department updated multiple physician drug codes retroactively due to a rate update from the Centers for Medicare & Medicaid Services (CMS). These new rates were implemented on July 30, 2025.

See the table below for the revised rates and their effective dates. 

Procedure Code

Start Date

End Date

Revised Rate

Original Rate

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