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MaineCare NF Rate Reform Updates

On Tuesday, January 23rd, the Department of Health and Human Services presented to the Health and Human Services Committee on rate reform. We understand that two 90-minute stakeholder meetings are anticipated for mid-February and all nursing home providers are encouraged to attend. MHCA will send out those details when they become available. 

The Department's presentation acknowledged some of the challenges facing the sector including continued closures/ conversions and low occupancy relative to pre-pandemic levels. They also noted that the cost settlement system is administratively burdensome for providers and DHHS. We also know that the current case mix system (RUGs) is ending and that the conversation to Patient Driven Payment Model (PDPM) is coming.

The Department's rate reform objectives include the following:
  • Ensure rates are adequate to help enable sustained access to needed care and support facilities in achieving and retaining a permanent, well-trained work force. 
  • Incorporate feasible and appropriate case mix adjustment method.
  • Ensure rates keep pace with changes in costs of delivering the service.
  • Promote development of Alternative Payment Model (APM) that provides incentives for high value care.
Rate reform for nursing facilities is targeted to be implemented in January 2025. Residential Care/ Assisted Living rate reform is estimated to be at least six months later. 

MHCA continues to have representatives participating in various committees related to rate reform and has ongoing discussions with the Department. Stay tuned for additional information on stakeholder meetings in February.

Staff contact: awesthoff@mehca.org