MaineCare wanted to create a rate setting system that was transparent, consistent, and focused on equity. Their outdated system was none of these things. So, the agency began the difficult task of explaining the value of this change to their legislature and other policy leaders and encouraging them to invest in a new system, employing a multi-year campaign of evaluation and education. Ultimately, they prevailed, putting in place a modern, data-driven system that helps them support their Medicaid members’ needs as well as the entire network of providers.
An Equitable, Inclusive Foundation
A year-long, comprehensive assessment and comparison of best practices for provider reimbursement among state Medicaid agencies fueled MaineCare’s recommendation for reform. They prioritized building an equitable foundation and a required process to assure payments remain adequate, over time. With this focus, MaineCare ushered in a transparent, systemic reform with benchmarks for improvement. More broadly, the Maine law is built on an outreach and education campaign spanning three years. Outreach to state legislature, providers, and stakeholders illustrated shortcomings of the current rate setting system. Key stakeholders were engaged in intense collaboration and negotiation representing advisory committees, provider associations and patient advocacy groups.
The new law directs the Office of MaineCare Services to perform in several key areas:
- A set of principles and processes underpin MaineCare reimbursement rates which are subject to regular review.
- A transparent process for conducting rate studies that includes public notice, comment and review.
- Criteria for annual cost of living adjustments (COLAs) for services.
- Establishes a technical expert advisory panel, which codifies provider and stakeholder involvement in the process.
- A gateway to promote value-based payment models that tie reimbursement to provider performance on reaching policy goals.
An Agenda that Can’t Wait
The Office of MaineCare Services did not wait for passage of this bill to initiate its rate reform agenda. The biennial and supplemental budgets passed along with this bill invested $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. The $700 million investment included services for which rates had not been addressed in over a decade – including dated benchmarks to circa 2007 Medicare.
NAMD is pleased to recognize the Office of MaineCare Services with the 2022 Spotlight Award. Learn more about the other 2022 Spotlight Award winners here.