MaineCare Proposes Major Substantive Rule Changes for Home and Community-Based Services Reimbursement
Last updated 2026-08-27 · Source: maine.gov
Primary source: maine.gov: MaineCare Proposes Major Substantive Rule Changes for Home and Community-Based Services Reimbursement
Maine's Department of Health and Human Services (DHHS), Office of MaineCare Services, has proposed amendments to Chapter III, Section 20 of the MaineCare Benefits Manual (MBM). These changes establish reimbursement methodology for new home and community-based services (HCBS) and shift the publication of reimbursement rates to the Department's website, requiring legislative approval to become legally effective.
What this means for your practice
This proposed rule change has significant implications for healthcare businesses, particularly those providing Home and Community-Based Services (HCBS) for adults with other related conditions in Maine. The shift of specific reimbursement rates from the rule manual to the Department's website (22 M.R.S. § 3177-J) means providers must regularly consult the website for current rates, potentially requiring updates to billing systems and financial planning processes. Furthermore, the classification as a 'Major Substantive' rule means it requires Legislative approval before becoming legally effective, introducing a potential delay or modification risk. While an emergency rule is anticipated to align effective dates, operators should monitor the legislative process and MaineCare's website for final rates, procedure codes, modifiers, and billable units to ensure compliance and accurate billing under the Section 1915(c) waiver.
Augusta, ME – The Maine Department of Health and Human Services (DHHS), Office of MaineCare Services, Division of Policy, has announced a significant rulemaking proposal concerning the MaineCare Benefits Manual (MBM), Chapter III, Section 20. This section, titled 'Allowances for Home and Community-Based Services for Adults with Other Related Conditions,' authorizes services under a CMS-approved Section 1915(c) waiver.
Overview of Proposed Amendments
The Department proposes to amend the Chapter III, Section 20 rule with two primary objectives:
1. Reimbursement Methodology for New Services: To establish the reimbursement methodology for new services that are being added under a companion Chapter II, Section 20 rule. This indicates an expansion of services available under the HCBS waiver. 2. Rate Publication Shift: To remove rates of reimbursement for all services from the Chapter III, Section 20 rule. Instead, these rates will now be listed in Rate Schedules published on the Department's website, in accordance with 22 M.R.S. § 3177-J. The proposed rule will include the website address for current rates and the statutory authority for this approach.
While specific reimbursement rates will move to the website, the rule will continue to specify procedure codes, modifiers, and billable units. It will also retain provisions for annual cost-of-living adjustments, consistent with 22 M.R.S. § 3173-J(2)(D)(3). These cost-of-living adjustments are designed to meet the requirements for direct support worker wages as outlined in 22 M.R.S. § 7402(1).
Provisional Status and Legislative Approval
Notably, the proposed Chapter III, Section 20 rule is classified as a 'Major Substantive' rule. This designation means that it will only be provisional upon adoption by the Department. For the rule to become legally effective, it requires approval from the Maine Legislature.
To ensure that the new methodology and rate changes can become legally effective concurrently with changes to the Chapter II, Section 20 routine technical rule, the Department anticipates also adopting an emergency Chapter III, Section 20 rule. This emergency rule would bridge the gap until legislative approval for the major substantive rule is secured.
Public Hearing and Comment Opportunity
Stakeholders and interested parties have an opportunity to provide feedback on these proposed changes:
- Public Hearing: A hybrid in-person and remote (via Zoom) public hearing is scheduled for September 15, 2026, from 8:30 AM to 10:30 AM. The in-person location is the State Office Building, 109 Capitol Street, Augusta, ME, Conference Room(s) A & B. The Zoom meeting link is https://mainestate.zoom.us/j/89826042240 (Meeting ID: 898 2604 2240).
- Written Comments: Written comments must be received by 11:59 PM on September 25, 2026.
For questions or to submit comments, individuals may contact Megan Brooks, Policy Writer, Office of MaineCare Services, 11 SHS, 109 Capitol Street, Augusta, ME 04330-0011, or via email at [email protected]. The phone number is 207-624-6965, and the fax is 207-287-6106 (TTY: 711 for Deaf or Hard of Hearing).
Providers are encouraged to review the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml and participate in the public comment process to ensure their perspectives are considered.
Key Facts
| Detail | Value | |---|---| | Rule Title | 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual (MBM), Ch. III, Sec. 20, Allowances for Home and Community-Based Services for Adults with Other Related Conditions | | Type of Rule | Major Substantive (requires Legislative approval) | | Public Hearing Date | September 15, 2026 (8:30 AM - 10:30 AM) | | Comment Deadline | September 25, 2026, by 11:59 PM | | Status | Proposed Agency Rulemaking | | Contact Person | Megan Brooks, Office of MaineCare Services |
Frequently Asked Questions
What is the primary change proposed for MaineCare Benefits Manual, Chapter III, Section 20?
The Department proposes to establish reimbursement methodology for new services and to remove rates of reimbursement for all services from the rule, instead listing them on the Department's website.
Why will the reimbursement rates no longer be in the rule manual?
Reimbursement rates will be moved to Rate Schedules on the Department's website pursuant to 22 M.R.S. § 3177-J.
When will these proposed changes become legally effective?
As a major substantive rule, Chapter III, Section 20 requires Legislative approval before it can become legally effective. The Department anticipates adopting an emergency rule to align effective dates with Chapter II, Section 20 changes.
Where can providers find the current reimbursement rates once the change is effective?
The current rates of reimbursement will be available on the Department’s website, the address for which is stated in the proposed rule.
Are there any public input opportunities for this proposed rule?
Yes, a hybrid public hearing will be held on September 15, 2026, and written comments are accepted until September 25, 2026.