Section 45, Acute & Rehabilitation Hospital Providers: Reminder of Upcoming January 1, 2025, Outlier Methodology Changes

Dec 30, 2024

Effective January 1, 2025, MaineCare will implement its second phase of changes to our outlier payment methodology and update the hospital-specific Cost to Charge Ratios (CCRs).

Phase 2 changes to the methodology include:

• Reimbursement will be 90% of the costs that exceed DRG reimbursement by a standard cost-based threshold amount of $50,000 (previously $150,000)
• Move from a hospital-specific, charge-based threshold to a standard cost-based threshold

For more information about these changes, including the outlier formula, please see the Hospital Services Rate Reform Updates document that followed the June 11, 2024 forum.

For questions, please contact your Provider Relations Specialist.