An Act To Require Regular and Transparent Review of MaineCare Reimbursement Rates
Maine Legislature, Session 129, LD 1052
Committee: Health and Human Services
Sponsors: FARNSWORTH, CLAXTON, MOORE, TIMBERLAKE, BICKFORD, CRAVEN, GATTINE, GRIFFIN, MADIGAN
Amends: 5 MRSA §12004-I, 22 MRSA §3122

Legislative Document
No. 1052
S.P. 312
In Senate, February 28, 2019
An Act To Require Regular and Transparent Review of MaineCare 
Reimbursement Rates
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator SANBORN, H. of Cumberland.
Cosponsored by Representative FARNSWORTH of Portland and
Senators: CLAXTON of Androscoggin, MOORE of Washington, TIMBERLAKE of 
Androscoggin, Representatives: BICKFORD of Auburn, CRAVEN of Lewiston, GATTINE of 
Westbrook, GRIFFIN of Levant, MADIGAN of Waterville.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA §12004-I, sub-§36-F is enacted to read:
36-F.   
Sec. 2.  22 MRSA c. 852 is enacted to read:
CHAPTER 852
MAINECARE REIMBURSEMENT RATES REVIEW
§3121.  Review of MaineCare reimbursement rates
1.  Review schedule.  No later than January 1, 2020, the department shall establish a 
schedule for ongoing review of reimbursement rates under MaineCare so that each 
reimbursement rate is reviewed at least every 3 years.  The review schedule must be 
submitted to the joint standing committees of the Legislature having jurisdiction over 
health and human services matters and appropriations and financial affairs.  The schedule 
may be altered in response to recommendations by the advisory committee established 
under section 3122 or the Legislature.
2.  Exclusion from review.  The department shall review under subsection 1 each 
service reimbursed by MaineCare, except that it may exclude services with 
reimbursement levels that are:
A.  Reviewed or updated on a regular basis according to a process established in state 
or federal rule or law;
B.  Based on cost;
C.  Contracted through a managed care or capitated rate; or
D.  Based on regularly updated Medicare rates.
The review schedule submitted to the joint standing committees pursuant to subsection 1 
must include a list of those rates not subject to regular review.
3.  Review.  Each review of a service undertaken by the department pursuant to 
subsection 2 must include:
A.  An analysis of the access, service, quality and utilization of the service;
B.  A comparison of rates with other available reimbursement rates, including 
Medicare, insurance or private pay rates;
C.  Provider retention of employees;
Human Services
MaineCare 
Reimbursement 
Rates Review 
Advisory Committee
Expenses Only
MRSA §3122
D.  Acceptable industry productivity standards;
E.  Participation and survey of current provider costs;
F.  Consideration of service access and cost in rural areas;
G.  Consideration of needs and costs for specific population groups; and
H.  Input from the advisory committee.
The department shall work with the advisory committee and the providers of the service 
being reviewed to determine responses and strategies to the review findings.
4.  Annual report.  The department shall provide an annual report, no later than 
December 1st of each year, beginning in 2020, that includes the results of the review of 
each service reviewed pursuant to subsection 2 in the most recent year, including the 
analysis under subsection 3 and any actions taken in response to the review, and any 
changes to rates reviewed by the department pursuant to this chapter, to the joint standing 
committees of the Legislature having jurisdiction over health and human services matters 
and appropriations and financial affairs.  The department shall also submit the report to 
the Governor together with recommendations for rate increases for consideration for 
inclusion in the biennial budget.
§3122.  Advisory committee
The MaineCare Reimbursement Rates Review Advisory Committee, referred to in 
this chapter as "the advisory committee," is established as provided in Title 5, section 
12004-I, subsection 36-F to make recommendations to the department regarding review 
of MaineCare reimbursement rates pursuant to section 3121.
1.  Membership.  The advisory committee has the following 21 voting members and 
one ex officio, nonvoting member:
A.  Six members appointed by the President of the Senate:
(1)  A representative of providers of community behavioral health services 
recommended by a statewide association of providers of behavioral health care 
services;
(2)  A representative of hospitals providing services to MaineCare members 
recommended by a statewide association representing hospitals;
(3)  A representative of providers of nonemergency medical transportation 
services to MaineCare members;
(4)  A representative of a rural health clinic;
(5)  A representative of home health care providers recommended by a statewide 
association representing home health care providers; and
(6)  A representative of providers of durable medical equipment recommended by 
a statewide association of durable medical equipment providers;
B.  Six members appointed by the leader of the largest minority party in the Senate:
(1)  A representative of primary care physicians serving MaineCare members 
recommended by a statewide association representing physicians;
(2)  A representative of dentists serving MaineCare members recommended by a 
statewide association representing dentists;
(3)  A representative of federally qualified health centers recommended by a 
statewide association of federally qualified health centers;
(4)  A representative of nonmedical home and community-based services;
(5)  A representative of providers serving MaineCare members with intellectual 
disabilities or autism recommended by a statewide association of providers of 
services to individuals with intellectual disabilities or autism; and
(6)  A MaineCare member living with a chronic behavioral health condition or a 
family member or guardian of a MaineCare member living with a chronic 
behavioral health condition;
C.  Five members appointed by the Speaker of the House of Representatives:
(1)  A representative of providers of substance use disorder services 
recommended by a statewide association representing behavioral health services;
(2)  A representative of psychiatric physicians recommended by a statewide 
association representing psychiatric physicians;
(3)  A representative of ambulatory surgical centers;
(4)  A representative of hospice providers recommended by the Maine Hospice 
Council established in section 8611; and
(5)  A representative of long-term care facilities recommended by a statewide 
association representing nursing facilities or assisted living facilities;
D.  Four members appointed by the leader of the largest minority party in the House 
of Representatives:
(1)  A family member of a child with disabilities receiving MaineCare services;
(2)  A representative of pharmacists serving MaineCare members recommended 
by a statewide association representing pharmacists;
(3)  A representative of nurses recommended by a statewide association 
representing nurses; and
(4)  A representative of physical therapists or occupational therapists 
recommended by a statewide association representing physical therapists or 
occupational therapists; and
E.  The commissioner or the commissioner's designee, who is an ex officio, 
nonvoting member of the advisory committee and shall attend meetings.
2.  Terms of office.  Each appointed member of the advisory committee serves a 4-
year term and may be reappointed.  A member is no longer qualified to serve if that 
member no longer meets the qualifications of appointment.
3.  Meetings; chair.  The advisory committee must meet at least once every calendar 
quarter and may meet more often and as necessary to fulfill its statutory duties.  Members 
shall elect a chair and vice-chair from among its members annually.  Chairs and vice-
chairs may be reelected.  Meetings are public proceedings in accordance with Title 1, 
chapter 13.
4.  Duties.  The advisory committee has the following duties:
A.  Review the 3-year schedule developed by the department and recommend, by 
majority vote of the advisory committee, any changes to the review schedule under 
section 3121, subsection 1;
B.  Provide advice and input to the department concerning reviews of rates;
C.  Hold public hearings, as considered necessary, to receive public testimony from 
providers of MaineCare services and other interested parties, including members of 
the public; and
D.  Review the department's reports and schedules and submit an annual report no 
later than December 1st of each year beginning in 2020 describing the advisory 
committee's activities, with recommendations to the joint standing committees of the 
Legislature having jurisdiction over health and human services matters and 
appropriations and financial affairs.
5.  Staffing.  The department shall provide staffing to the advisory committee 
including administrative services, report writing, publishing and organizing meetings and 
arranging meeting locations.
Sec. 3.  Staggered terms; appointments.  Notwithstanding the Maine Revised 
Statutes, Title 22, section 3114, subsection 2, the appointing authorities for the original 
appointments of members to the MaineCare Reimbursement Rates Review Advisory 
Committee shall each designate their first 2 appointments to 2-year terms, their 2nd 2 
appointments to 3-year terms and any other appointments to 4-year terms.  The 
appointing authorities shall make appointments no later than 60 days after the effective 
date of this Act.
SUMMARY
This bill establishes a regular review process for MaineCare reimbursement rates.  
The Department of Health and Human Services shall review all rates over a 3-year period 
except those that are already subject to regular review, based on cost, reimbursed at a 
capitated rate, or tied to Medicare or some other rates.  The 3-year schedule and the 
reviews are required to be submitted to the joint standing committees of the Legislature 
having jurisdiction over health and human services matters and appropriations and 
financial affairs.  The results of reviews are also submitted to the Governor for 
consideration for inclusion in the biennial budget.  The bill also establishes the 
MaineCare Reimbursement Rates Review Advisory Committee made up of stakeholders 
appointed by the Presiding Officers and the minority leaders in the Legislature to provide 
advice and input to the department on rate reviews.  The advisory committee also submits 
an annual review of its activities to the joint standing committees of the Legislature 
having jurisdiction over health and human services matters and appropriations and 
financial affairs.  The advisory committee is staffed by the Department of Health and 
Human Services.