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Archive July 2026

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Nursing Facility (NF) Days Awaiting Placement (DAP) and Critical Access Hospital (CAH) Swing Bed Rates Updates

Effective July 1, 2026, the NF DAP and CAH swing bed rates are recalculated for State Fiscal Year 2027. You can view both related memos on the rate setting page of the Health PAS Online Portal. 

The following new rates are effective for services delivered on, or after, July 1, 2026, through June 30, 2027.
  • NF DAP rate is $129.68 per day
  • CAH swing bed rate is $409.34 per day
The NF DAP is for NFs with members awaiting placement to a lower level of care in a Residential Care Facility.
Adjustment Billing Guidance for Dates of Service July 1, 2026 - July 22, 2026
  • Providers are responsible for adjusting claims submitted with charges below the new rates within 120 days of the most recently paid claim
  • MaineCare will adjust claims that were billed and paid at or above the new rates  
For questions, please contact the following provider relations specialists: Staff contact: awesthoff[at]mehca.org

New Rates Implemented for Residential Care Facilities (Section 97- Appendix C)

As previously announced, MaineCare updated Section 97, RCF rates effective July 1, 2026. They implemented these rates for billing on July 15, 2026.

Adjustment Billing Guidance for Dates of Service July 1, 2026 – July 14, 2026
Providers are responsible for adjusting all affected claims. Per policy and to avoid timely filing denials, you must submit adjustments within 120 days of the most recent claim payment date.  For additional billing guidance when adjusting or reversing claims, please see the How to Adjust Claims for Retro Rate Increases (PDF) document.

Updated rate letters are available on the secure Health PAS Online Portal.

For questions on these rates, please contact the representative listed on your rate letters.

For all other questions, please contact your Provider Relations Specialist.

Staff contact: awesthoff[at]mehca.org

Updated ICD-10 Code Database for PDPM Now Available (FY2027)

CMS has released an updated version of the Microsoft Access database containing the ICD-10 codes used for item I0020B on the MDS. The refreshed database reflects the code set that will take effect October 1, 2026, marking the start of FY2027, and is available for download as a ZIP file directly from CMS.
Item I0020B captures each resident's primary diagnosis and directly drives PDPM clinical category assignment, so getting the code lookup right matters for accurate reimbursement. Facilities and MDS coordinators should download the updated database and confirm it's incorporated into their coding workflows and software well ahead of the October 1 effective date.
For more background on MDS technical resources, visit CMS's Minimum Data Set technical information page.
 
Staff Contact: mcarland[at]mehca.org

August 2026 MDS NF Forum Call

The next NF Forum call will be held on August 6, 2026 at 1 pm.  
To register click here
 
Staff Contact: mcarland[at]mehca.org
 

CMS Announces Nationwide Expansion of Risk-Based Surveys

CMS has released long-awaited guidance implementing the Nursing Home Risk-Based Survey (RBS) process nationwide, effective September 8, 2026.
Expanding RBS was one of AHCA's key recommendations under its Better Way agenda, and today's announcement — driven by AHCA advocacy led by Maine's own Holly Harmon — is expected to ease staff burden, reduce survey backlog, and reward high-quality care.

Building on a pilot conducted across 22 states since 2023, RBS directs limited state survey resources away from consistently high-performing facilities so states can focus on higher-risk providers. Qualifying facilities will still be surveyed at least every 15 months, and states retain the ability to conduct a traditional survey at any RBS-qualifying facility if concerns arise (e.g., complaints). About 12% of nursing facilities nationwide are expected to qualify initially.

To qualify, a facility must meet several criteria each quarter, including a 5-star overall rating, a 3-star (or better) staffing rating, no citations for Actual Harm, Immediate Jeopardy, or Substandard Quality of Care in the last survey cycle, a standard survey within the last 18 months, no active staffing waivers, passing PBJ and MDS audits, a Health Inspection Score at or below the state's 50th percentile, no unexplained new schizophrenia diagnoses in residents 65+, and no recent change of ownership. Special Focus Facility candidates are also excluded.

Beginning September 30, 2026, CMS will publish a quarterly list of RBS-qualified facilities on its Provider Data Catalog, and qualifying facilities will display a gold trophy icon on the Care Compare tool at Medicare.gov. State agencies will receive quarterly qualification lists from CMS ahead of each cycle.

See QSO-26-14-NH and the announcement from CMS for more information.

Staff contact: mcarland[at]mehca.org
 
 
 

PBJ Data for Q3 is Due August 14, 2026

The deadline to submit Payroll Based Journal (PBJ) data for Quarter 3 (April 1–June 30, 2026) is August 14, 2026. If you have not already submitted your data, now is the time to complete your submission and avoid last-minute issues.  
Review Your PBJ Data Before Submitting 
Whether your PBJ data is submitted by facility staff or a third-party vendor, the facility is ultimately responsible for the accuracy and completeness of the submission. Before submitting, complete a final internal review to ensure your data is accurate. 
At a minimum, verify that you have: 
  • Reviewed all reported staffing hours, including Medical Director hours.  
  • Deducted the required meal breaks.  
  • Validated employee IDs and job codes.  
  • Confirmed the correct reporting quarter was selected.  
  • Reviewed validation reports for errors or warnings.  
  • Ensured your submission was accepted and no files were rejected. 
 
Review the Final File Validation Report 
  • Confirm the file was accepted.  
  • Verify the report contains the correct reporting quarter and facility data.  
  • Review any warnings or errors that require correction.  
  • The Final File Validation Report is typically available in CASPER within 24 hours of submission.  
Validate Your Submission  
After submission, don't assume the process is complete. Review the available PBJ CASPER reports to confirm your staffing data was processed as expected and identify any issues that should be corrected before the submission deadline. 


Final Reminder 
Do not wait until the last day to submit your PBJ data. Early submission provides time to review validation reports, correct any errors, and resubmit, if necessary, before the August 14, 2026, deadline. 

Prepare Now for the Transition to iQIES 
While the August 14, 2026, deadline is the immediate priority, providers should also begin preparing for the transition of PBJ reporting to the Internet Quality Improvement and Evaluation System (iQIES). Beginning August 17, 2026, all PBJ submissions and reporting activities will be completed in iQIES, and Quarter 4 (July 1–September 30, 2026) data must be submitted through iQIES by November 14, 2026.  
CMS recently released QSO-26-12-NH, which outlines what providers should expect during the transition, including: 
  • PBJ submissions through the current QIES system will end after the August 14 deadline.  
  • PBJ reports will be available in iQIES beginning August 17, including up to 10 years of historical PBJ data (with limited exceptions).  
  • Providers should ensure all staff responsible for PBJ reporting have established HARP accounts, requested the appropriate iQIES role, and obtained approval from their facility's Provider Security Official (PSO) before the transition.  
 
Providers are encouraged to review the CMS memo QSO-26-12-NH and begin preparing now to ensure a smooth transition. 
 
AHCA Resources for PBJ Support  
AHCA has developed several resources to help providers prepare for both the current submission deadline and the upcoming transition to iQIES: 
  CMS provides several tools to assist providers: 
CMS Support: Live phone and email support for August 14, 2026, PBJ Deadline?will be available through Friday, August 14, 2026, until 8:00 PM ET. All files must be submitted by August 14, 2026, at 11:59 PM ET. Files for Fiscal Quarter 3, with the reporting period of April 1 through June 30, will not be accepted after this deadline.  Members may direct PBJ questions to regulatory@ahca.org.?
?
 
Staff contact: mcarland[at]mehca.org
 

Maine UTI and C. Diff Reporting in NHSN is Due by August 15, 2026

Per Rule 90-590 Chapter 270, Uniform Reporting System for Health Care Quality Data Sets requires all nursing facilities to submit Clostridium difficile Lab ID Events and all UTI Events as outlined in NHSN. 
 
The August 15the deadline is for Quarter 1 (January, February, March) 2026. Facilities must report for each quarter, including months where no events occurred.
To avoid potential fines, please ensure data submission by the deadline.
It is strongly recommended that you input your reporting plan for the entire year.  Maine CDC has developed a step by step guide to assist you in inputting this data! 
 Click here for the complete guide
 
 
 
Staff contact: mcarland[at]mehca.org
 
 

GUIDE Model Update: Why Assisted Housing Providers May Be Contacted About New Partnership Agreements

As the Centers for Medicare & Medicaid Services (CMS) rolls out updates to the Guiding an Improved Dementia Experience (GUIDE) Model, assisted housing (RC and AL)  providers may start hearing from GUIDE Participants about new or updated partnership agreements. These agreements are meant to bring existing partnerships into compliance with new CMS requirements that took effect July 1, 2026.
For many assisted housing providers, it's worth understanding up front: this request comes from CMS, not from the GUIDE Participant itself. The updated agreements exist to keep GUIDE Participants in compliance with the Model's revised requirements for residential care communities (RCCs) — so if your organization is contacted, it's part of a broader regulatory change, not a change your GUIDE Participant partner chose to make on their own.
What Is the GUIDE Model?
GUIDE is an eight-year, voluntary Medicare model that was launched in July 2025 to improve care coordination and quality of life for people living with dementia and their caregivers. GUIDE Participants — Medicare Part B-enrolled providers and suppliers selected by CMS — may partner with RCCs, including assisted housing communities, to deliver certain GUIDE services through a written partnership agreement.
What Changed on July 1, 2026
CMS established a new regulatory framework for assisted housing participate in the GUIDE Model. Under the revised rules, GUIDE Participants that currently partner with assisted housing communities — or want to in the future — must:
  • Obtain CMS approval before adding them as a partner
  • Execute partnership agreements that meet CMS's new compliance standards
  • Submit additional information about their Partner Organizations
As part of this process, assisted housing providers may be asked to share information about ownership and controlling interests, related organizations, governance, and general organizational structure, so that GUIDE Participants can satisfy CMS's reporting and oversight requirements.
Other Operational Changes to Know
Along with the new partnership framework, CMS made several other changes that affect assisted housing providers:
  • Memory care exclusion: Residents of dedicated memory care communities or units are no longer eligible to participate in GUIDE.
  • Respite services: GUIDE respite services are no longer available to residents of assisted housing communities, regardless of whether they have a primary caregiver.
  • New payment category: CMS established a separate payment category specifically for GUIDE Participants.
What assisted housing Providers Should Do Now
If your community currently participates in GUIDE — or is considering it — take time to:
  • Carefully review any partnership agreement a GUIDE Participant sends you
  • Understand what disclosures you may be asked to provide
  • Prepare the organizational and governance information CMS now requires
  • Evaluate how the memory care exclusion, respite changes, and new payment structure may affect your residents and operations
Resources Questions?
Contact AHCA's Population Health Policy Analyst Rohini Achal or Nisha Hammel, Vice President, Reimbursement Policy & Population Health.
 
Staff contact: mcarland[at]mehca.org

New Labor Laws Going into Effect

Below you'll find an overview of some of the newly effective Maine labor laws. Please forward this to your HR/compliance managers so they are aware. 
 
Pay Transparency
LD 54 – An Act to Require Employers to Disclose Pay Ranges and Maintain Records of Employees' Pay Histories establishes new pay transparency requirements. Beginning July 29, employers with 10 or more employees must include the anticipated pay range in advertisements for available positions. Current employees may also request the pay range for their position. Employers must maintain records concerning employee positions and pay history during employment and for three years after separation.
 
Employer Surveillance 
LD 61 – An Act to Regulate Employer Surveillance to Protect Workers establishes new notice and privacy requirements regarding electronic workplace surveillance.
Employers that engage in covered forms of electronic monitoring must notify prospective employees during the hiring process and provide annual written notice to current employees. The law also limits audiovisual monitoring in employees' residences, personal vehicles and personal property, and allows employees to decline requests to install employer surveillance applications on their personal electronic devices. 26 MRS §620 prohibits employers from retaliating against employees who exercise their rights under this law (and all the other labor protections in Title 26, Chapter 7).
 
Health Care Noncompete Agreements
LD 2200 – An Act to Prohibit Noncompete Agreements for Health Care Professionals expands worker mobility within Maine's health care workforce. The law prohibits employers from requiring noncompete agreements for health care practitioners while preserving existing protections contained elsewhere in Maine law.
 
Workplace Safety
LD 1993 – An Act to Increase the Annual Cap on Funds Assessed for the Safety Education and Training Fund increases the statutory cap supporting the Safety Education and Training Fund. The fund supports workplace safety education and training programs administered by the Maine Department of Labor that help employers identify hazards, prevent injuries and create safer workplaces across Maine.
** To review Maine DOL's SafetyWorks! Program, including training schedules, safety video library, and resources click here. 
 
Substance Use Testing Modernization
LD 2110 – An Act to Update Employer Substance Use Testing Policy Requirements modernizes Maine's workplace substance use testing laws. Among other changes, the law requires the use of Medical Review Officers in applicable circumstances, authorizes qualifying employers to use rapid oral fluid screening devices, incorporates breath alcohol testing into the statute, updates terminology, clarifies reasonable suspicion standards, revises treatment provisions and updates several statutory definitions.
 
Health Care Gap Year Program
LD 703 – An Act to Establish a Health Care Gap Year Program for Recent College Graduates provides funding to expand career pathways into Maine's health care workforce. The initiative supports placement of recent college graduates into critical health care positions, particularly in rural and underserved communities, while helping employers address workforce shortages.
**To learn more about the Gap Year program that runs through The Roux Institute at Northeastern University with support from Maine's Department of Labor, click here. 
 
Paid Family and Medical Leave
LD 2018 – An Act to Amend the Requirements Governing Self-Insurance Plans in the Paid Family and Medical Leave Benefits Program clarifies requirements for employers operating self-insured private plans. The law establishes bond requirements, clarifies that employers may not pool insurance risk across multiple employers and reinforces safeguards that protect workers' access to Paid Family and Medical Leave benefits.
 
To learn more about these and other labor laws follow this link to watch a recording of a July 16 webinar the Maine Department of Labor held to share information about these recent changes to Maine state law and regulations on wage and hour, workplace safety, and other labor standards. 

AHCA NCAL Provides Wildfire Smoke Resources for LTC

As wildfire season continues to impact air quality across many parts of the country, long term care providers should be prepared to protect residents, staff, and visitors from the health effects of wildfire smoke. Older adults and individuals with chronic heart or lung conditions are among those most vulnerable to smoke exposure, making preparedness especially important for nursing homes and assisted living communities.  Depending on your hazard vulnerability assessment, adding this to you EOP may be warranted. 
The following federal resources can help your facility monitor air quality, prepare for smoke events, and reduce exposure when wildfire smoke affects your community. 

The CDC recommends that long term care providers review their emergency preparedness plans to help protect residents, staff, and visitors during wildfire smoke events. Key actions include: 
  • Monitor air quality using AirNow.gov. 
  • Improve indoor air quality by keeping smoke outside and using portable air cleaners or appropriate air filtration when possible. 
  • Know local evacuation plans and follow guidance from emergency management officials. 
  • Review emergency supplies and plan for residents who are more vulnerable to wildfire smoke, including older adults and those with chronic health conditions. 
  • Use the CDC's Outdoor Air Quality Communication Toolkit for ready-to-use resources to communicate with staff, residents, and families. 
Learn more about wildfire smoke preparedness on the CDC's Wildfire Smoke webpage.? 
Other Resources for Preparedness:  Health and Safety Fact Sheets Key Takeaways
Wildfire smoke can affect communities hundreds of miles from an active fire. Incorporating these federal resources into your emergency preparedness planning can help your organization: 
  • Monitor current and forecasted air quality conditions. 
  • Identify resources to support resident and staff safety during smoke events. 
  • Improve indoor air quality planning. 
  • Access educational materials for staff, residents, and families. 
  • Enhance communication and preparedness efforts before and during wildfire season. 
By staying informed and planning ahead, long term care providers can better protect residents, staff, and visitors when wildfire smoke affects their communities. 

For additional support, please contact emergencyprep@ahca.org.   
 
Staff contact: mcarland[at]mehca.org
 
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