Maine DHHS unveils payment reform for behavioral health

By Christina P. O'Neill
April 5th, 2023

The Maine Department of Health and Human Services (DHHS) has instituted a $237 million increase in behavioral health investments of federal and state funds to continue MaineCare, the state’s Medicaid program, and related payment improvements, effective January 1, 2023.

In a January 11 blog post, DHHS outlined the proposed impact of its rate reform package, which will support Maine residents’ access to and coordination of community-based mental health, medical, and social services. Rate increases will support mental health and substance use disorder services and ‘targeted case management.’.

The DHHS post cites investment in children’s behavioral health system ($17 million) to support a new system and staff to connect children with needed services. Maine Governor Janet Mills, who took office in January 2019, has proposed an additional $7 million to respond to the state’s opioid crisis, with the state Office of Behavioral Health (OBH) funding complementing both MaineCare payments and the $28 million in opioid litigation settlement funds. The settlement funds from Johnson & Johnson and distributors are to be allocated by the state’s Recovery Council, state Attorney General and municipalities this year, DHHS stated.

The $28 million is part of an ongoing $130 million, 18-year settlement agreement.

The state’s proposed biennial budget (FY 2024-2025, July 1 2024 to June 30 2025) includes $213 million to continue payment improvements, including related OBH and Office of Child and Family Services state-funded programs, and $46 million to update behavioral health payments for cost-of-living adjustments and housing costs to reflect higher than expected inflation, DHHS stated.

As of January 1, 2023, MaineCare payment rates have been updated for more than 115 discrete services in five policy areas:

• Targeted Case Management: 6.6% median increase
• Community Support Services: 59.2% median increase
• Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations: 72.3% median increase
• Behavioral Health Services: 22.0% median increase
• Behavioral Health Home Services: 43.0% median increase.

The new rate reform system also provides a system to review and update MaineCare rates on a regular basis. Maine law requires rate updates to be data-driven, occurring at regular intervals and including avenues for provider and stakeholder feedback.

Previously, MaineCare used varying methods to determine provider rates, including payments based on a percentage of Medicare rates, industry standards, or other states’ rates; legislative mandates or rate studies; and actuarial assessment or provider input. Many reviews didn’t have a set schedule and as of January 21, 2020, 40 percent of policies hadn’t been updated since 2015.

The text of An Act to Codify MaineCare Rate System Reform, enacted April 20, 2022, calls for rate reforms to require the following:

• Determination of whether a Medicare rate is available for the service and whether it represents the most appropriate benchmark and payment model;
• In the absence of a Medicare model, determine whether a rate from a non-Medicare payer source represents the most appropriate benchmark and payment model; and
• Consider adopting alternative payment models using financial incentives to promote or leverage greater value for MaineCare.

In the 2023 state fiscal year, the new rate increases will be funded by a down payment in the FY2022 supplemental budget and the Medicaid Stabilization Fund, DHHS stated.

“These historic improvements in Maine’s payments for behavioral health will expand capacity and help Maine residents be healthy and resilient,” stated Sarah Squirrell, permanent director of OBH, which oversees the delivery of mental health and substance use disorder services for Maine residents. “They are needed at a time when providers continue to struggle with pandemic-related inflation and workforce challenges and will speed recovery and strengthen our behavioral health system for the long run.”

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