Augusta, ME - The Maine Department of Health and Human Services (DHHS) announced on April 29th, that Governor Janet Mills has signed bipartisan legislation to enshrine into state law a new system for setting MaineCare payment rates that promotes equity, consistency, and transparency. The reforms support high-quality health care for Maine people and fair and sustainable reimbursement to Maine's health and social services providers.

The bipartisan bill, which was proposed by DHHS and improved by the Legislatures Health and Human Services Committee, codifies the Departments sweeping and unprecedented plan to transform MaineCare (Maines Medicaid program) rate setting from a fragmented, often outdated and arbitrary approach into a coherent, streamlined and data-driven system, now and into the future. The plan is a culmination of Governor Mills directive to DHHS on her first day in office to expand MaineCare and develop a plan to make the health coverage program for low-income people more accessible, affordable, and sustainable.

The Departments plan is grounded in a comprehensive evaluation of Maines rate system completed by the Office of MaineCare Services in 2021. This evaluation assessed the current system against best practices for provider reimbursement and other state Medicaid programs, identified priority services overdue for investment, and developed recommendations for the Department to act across all services covered by MaineCare.

The bill enacts a new stand-alone section of Maine law that creates a foundation and infrastructure to invest appropriately and equitably in MaineCare reimbursement.

"This legislation creates a strong, sustainable framework that will endure well into the future for Maines health coverage system that supports more than 380,000 residents," said DHHS Commissioner Jeanne Lambrew. It paves the way for MaineCare rates that are developed through a transparent, data-driven process that puts providers on an equal playing field, incorporates member input, and improves access to high-value services for Maine people.

The Departments bill was presented by Representative Michele Meyer (D-Eliot) and co-sponsored by Senator Ned Claxton (D-Androscoggin), Senator Marianne Moore (R-Washington), and Representative Abigail Griffin (R-Levant), the Chairs and Leads of the Legislatures Health and Human Services Committee at the time of the bills introduction.

This bill paves the way for a fair, transparent and comprehensive reevaluation of MaineCare rates that will help to assure access to high-quality health care for Maine people, said Senator Ned Claxton and Rep. Michele Meyer, chairs of the Health and Human Services Committee. We appreciate the extensive input from stakeholders and the work of the Department of Health and Human Services that led to this bills successful passage.

MaineCare rate reform has been a very high priority for the Health and Human Services Committee, said Senator Marianne Moore and Rep. Kathy Javner (R-Chester), who resumed her role as House Republican lead on the Committee following the bills introduction. We have heard from numerous stakeholders that change needed to happen. The passing of LD 1867 was the result of valuable collaboration among legislators and the Maine Department of Health and Human Services and we look forward to the real reform it will bring.

The bill advances the Administrations MaineCare reforms by directing DHHS to:

- Establish MaineCare reimbursement rates according to defined principles and processes, including benchmarking to other payers rates, adhering to a regular schedule for reviewing rates, reviewing relevant data such as provider costs and national best practices, and considering factors such as the degree to which a particular service is dependent on MaineCare reimbursement

- Establish a clear and transparent process for conducting rate studies, including public notice, public presentation and comment on proposed rates, and a public response to comments, including how feedback was incorporated

- Make annual cost-of-living adjustments (COLAs) for services that have not received a rate adjustment in the prior 12 months, according to appropriate criteria for calculating COLAs

- Establish an expert advisory panel to inform technical matters relating to MaineCare rates, such as rate review schedules and payment models, to codify provider and stakeholder involvement in the process

- Consider ways to promote greater value in MaineCare, such as through alternative payment models that tie reimbursement to provider performance

This law will have significant positive impact by creating a transparent and structured approach to establishing MaineCare payment rates for health care services guided by data, technical advisory expertise and providers of MaineCare services, said Lisa Harvey-McPherson RN, Northern Light Health Vice President of Government Relations. We thank the Legislature and the Governor for supporting this important legislation.

LD 1867 represents a collaborative approach with providers, mapping out a process to ensure that MaineCare rates across a broad spectrum of health care services remain cost effective, while also keeping pace with the evolvingand increasingly complexhealth care needs of Maine people, said Darcy Shargo, CEO of the Maine Primary Care Association.

When MaineCare rates pay enough to support strong provider participation, it means our health care system is easier for Mainers with low incomes to access, said Kathy Kilrain del Rio, Advocacy and Programs Director for Maine Equal Justice. We are hopeful that the thoughtful process created by LD 1867 for the regular review and adjustment of rates will lead to a stronger provider network for the many types of services needed by MaineCare members across the state."

The biennial and supplemental budgets invest $700 million in federal and state funds in MaineCare rates, including rate increases to support 125 percent of minimum wage for direct support worker wages, make one-time COVID-19 supplemental payments, and implement recently concluded rate studies.

Since taking office, Governor Mills has expanded health care to more than 94,000 people through MaineCare expansion. In total, the program provides health coverage to over 380,000 Maine people, or one in four residents.

She has additionally preserved health coverage protections for Maine people, including those with pre-existing conditions; launched CoverME.gov, Maines new Health Insurance Marketplace, with more than 66,000 Maine people selecting plans for 2022, an increase of more than 10 percent over the previous year; cut Maines uninsured rate to 5.1 percent, below the national average; lowered health care costs for nearly 6,000 small businesses and over 47,000 of their employees and families; and expanded access to dental care, reproductive health care, and more.