For those of us who have worked in the State’s mental health system for a while – and for me, it’s been several decades – the reimbursement rates for MaineCare (Medicaid) services are of great concern and interest.

Earlier this year, the state contracted with an organization to review reimbursement rates paid to providers, in order to present a proposal to the Legislature, which has the final say on how much is paid out. This is a comprehensive study, so is addressing all provider services, not just mental health, as you’ll see below.

Reimbursement rates are notoriously low, yet the cost of doing business with the state is very much higher than doing business with any other form of insurance (and of course, MaineCare is insurance). Not only is there far more paperwork involved, but the licensing process is burdensome and the State ends up acting as Judge, Prosecution and Jury, as well as collections agent, when it comes to determining whether or not a provider is meeting its standards.

The rationale, of course, is that it’s taxpayer money, therefore it must be protected against fraud – and there have been some very high profile, and expensive, cases of the system being milked by unscrupulous organizations.

In any event, the cost of everything goes up every single year, while reimbursement rates have remained stagnant, forcing providers to do more with less. In the end, everyone is damaged: the State, which doesn’t get the quality of service it expects and is paying for; the providers, who cannot find enough staff to do the demanding work; the community, which feels it’s being taxed to death with minimal outcomes; and those being served, who get short shrift through no fault of their own.

Maine Department of Health & Human Services sent this bulletin at 11/20/2020 09:21 AM EST

MaineCare Comprehensive Rate System Evaluation

Phase 2 Stakeholder Engagement

This is a notice regarding the next phase of stakeholder engagement activities for MaineCare’s Comprehensive Rate System Evaluation, which are scheduled to begin December 2, 2020, and will serve as an opportunity for MaineCare providers to share comments on the adequacy of MaineCare rate amounts and impact these rates may have on access to services. This will include feedback on the Phase 1 benchmarking report, which will be released before Thanksgiving. 

We will send out a notification when the benchmarking report is available on our website. 

To prepare for the meetings, we ask that participants review the report prior to their session(s) and think about any important factors that were not accounted for in the report that you would like to note for consideration.   

The meeting schedule is below (please note that some groupings have changed since the Phase 1 meetings). Information about how to register for these meetings will be forthcoming.  

Providers and other interested parties who would like to submit comments in writing may do so by sending an email to RateSettingEval@maine.gov. We will accept written comments until Wednesday, December 9th.  

Following these meetings, we will develop the Phase 2 plan for a comprehensive rate assessment process, which will include:  

• Recommendations for simplifying and streamlining rate methodologies, and for a process and structure for ongoing rate review and rebasing;  
• A priority list and work plan for short- and longer-term rate reviews; and 
• An estimate of the necessary investment to implement recommendations. 

Interim Phase 2 findings will be released mid-January 2021, and the final report in February. Please send any questions on this effort to RateSettingEval@maine.gov. For more information, please visit our website.  

Categories: MaineCare & Maine DHHS

Tags: Heritage Health Services, Legislature, MaineCare, rate setting