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.
|Wednesday, December 2, 2020|
|8:00-10:30||Specialty Services Sec. 15: Chiropractic Services Sec. 68: Occupational Therapy Services Sec. 75: Vision Services Sec. 85: Physical Therapy Services Sec. 95: Podiatric Services Sec. 109: Speech and Hearing Services|
|12:00-2:30||Dental Services Sec. 25: Dental Services Sec. 90: Ambulatory Care Clinic Services, Oral Surgery Services only Sec. 3: Physician Services, Oral Surgery Services only|
|Thursday, December 3, 2020|
|8:00-10:30||Hospital Services Sec. 45: Hospital Services Sec. 46: Psychiatric Hospital Services|
|12:00-2:30||Nursing Facilities Sec. 67: Nursing Facility Services|
|Friday, December 4, 2020|
|8:00-10:30||Miscellaneous Services Sec. 5: Ambulance Services Sec. 55: Laboratory Services Sec. 60: Medical Supplies and Durable Medical Equipment Sec. 101: Medical Imaging Services|
|12:00-2:30||Physician, APRN, Primary Care, Ambulatory Care/Clinics Services Sec. 3: Ambulatory Care Clinic Services except Oral Surgery Services Sec. 4: Ambulatory Surgical Center Services Sec. 7: Free-Standing Dialysis Services Sec. 14: Advanced Practice Registered Nursing Services Sec. 30: Family Planning Agency Services Sec. 31: Federally Qualified Health Center Services Sec. 90: Physician Services except Oral Surgery Services Sec. 91: Health Home Services Sec. 94: Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT) Sec. 103: Rural Health Clinic Services|
|3:00-5:30||Residential Care Sec. 2: Adult Family Care Services Sec. 97: Private Non-Medical Institution Services- App B, C, D (except App D Therapeutic Foster Care), E, and F. Sec. 107: Psychiatric Residential Treatment Facility Services|
|Monday, December 7, 2020|
|8:00-10:30||Behavioral Health Services – Outpatient Sec. 17: Community Support Services – Day Supports Services Sec. 17: Community Support Services – Interpreter Services Sec. 17: Community Support Services – Skills Development Services Sec. 65: Behavioral Health Services- Behavioral Therapy Sec. 65: Behavioral Health Services- Intensive Outpatient Program (IOP) Sec. 65: Behavioral Health Services- Medication Assisted Treatment (MAT) Sec. 65: Behavioral Health Services- Medication Management Sec. 65: Behavioral Health Services- Neurobehavioral Sec. 65: Behavioral Health Services- Outpatient|
|3:00-5:30||Behavioral Health Services – Community-Based Sec. 13: Targeted Case Management Services Sec. 17: Community Support Services – Assertive Community Treatment Sec. 17: Community Support Services – Community Integration Services Sec. 17: Community Support Services – Community Rehabilitation Services Sec. 17: Community Support Services – Daily Living Support Services Sec. 28: Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations Sec. 65: Behavioral Health Services- ACT Sec. 65: Behavioral Health Services- Behavioral Health Day Treatment Sec. 65: Behavioral Health Services- Clubhouse Sec. 65: Behavioral Health Services- Crisis Sec. 65: Behavioral Health Services- Home and Community Based Treatment (HCBT) Sec. 92: Behavioral Health Home Services Sec. 93: Opioid Health Home Services Sec. 97: Private Non-Medical Institution Services, App D Therapeutic Foster Care only|
|Tuesday, December 8, 2020|
|8:00-10:30||Home and Community-Based Services for Members with Intellectual or Developmental Disabilities and/or Acquired Brain Injury and Other Related Conditions Sec. 18: Home and Community-Based Services for Adults with Brain Injury Sec. 20: Home and Community Based Services for Adults with Other Related Conditions Sec. 21: Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder Sec. 23: Developmental and Behavioral Clinic Services Sec. 29: Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Sec. 50: Intermediate Care Facilities for Individuals with Intellectual Disabilities Services Sec. 102: Rehabilitative Services|
|12:00-2:30||Home and Community-Based Services for Older Adults and Members with Physical Disabilities Sec. 12: Consumer Directed Attendant Services Sec. 19: Home and Community Benefits for the Elderly and Adults with Disabilities Sec. 26: Day Health Services Sec. 40: Home Health Services Sec. 43: Hospice Services Sec. 96: Private Duty Nursing and Personal Care Services|
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