Maine Regulation Digest / MaineCare Section 50 / 1 July 2025
Hornbeam reads MaineCare's publications every night and records what changed, quoting the source.
The Department corrected an FY26 ICF/IID rate-calculation error that had overinflated the variable rate; revised rate letters are available, effective 1 July 2025, in MaineCare Section 50.
§50 · effective 1 July 2025 · CR 141649 · detected 2026-08-16
The Department recently identified and corrected an error in the FY26 (July 1, 2025 – June 30, 2026) rate calculations for ICF/IIDs. This error resulted in overinflation of the variable rate.
For ICF/IID FY26, MaineCare corrected a rate-calculation error that had overinflated the variable rate for the period July 1, 2025, through June 30, 2026. Revised rate letters are available under change reference CR 141649. The prior and corrected rate amounts are not stated.
This applies to ICF/IID providers whose FY26 reimbursement includes the variable rate. The notice does not state that providers must submit a new form, change a billing code, or take another required action. It says revised rate letters are available, so the document identifies those letters as the source of the corrected rate information. Providers that do not bill the ICF/IID FY26 variable rate are not identified as affected by this change. The rule excerpt states that ICF-IID reimbursement uses prospectively determined rates and that facilities submit annual cost reports, but it does not add a new cost-reporting or billing requirement for this correction.
This document alone does not state how providers receive the revised letters, whether the corrected rate changes any claims already submitted, or how MaineCare will handle payments using the overinflated rate. It also does not state any individual provider’s revised rate.
| Applies to | What | Was | Now |
|---|---|---|---|
| Applies toICF/IID FY26 variable rate | Whatnotice# | Was— | Nowicf-iid-fy26-variable-rate |
From MaineCare Benefits Manual, 10-144 C.M.R. ch. 101. Quoted in part; the section itself is on maine.gov.
The purpose of these Principles is to comply with Section 1902(a)(13)(A) of the Social Security Act and the Rules and Regulations published thereunder (42 CFR Part 447) namely to provide for payment to Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID) through the use of rates that are reasonable and adequate to meet the costs incurred by efficiently and economically operated facilities in order to provide care and services in conformity with applicable State and Federal laws, regulations, and quality and safety standards.
1010 AUTHORITY
The authority of the Department of Health and Human Services to accept and administer any funds that may be available from private, local, State, or Federal sources for the provision of the services set forth in these Principles of Reimbursement is established in Title 22 of the Maine Revised Statutes Annotated, §10 and §12. These regulations are issued pursuant to authority granted to the Department of Health and Human Services by Title 22 of the Maine Revised Statutes Annotated §42(l).
1020 DEFINITONS
1021 Department as used throughout these Principles is the State of Maine Department of Health and Human Services.
1022 Designated Planning Agency as used throughout these Principles is the State of Maine Department of Health and Human Services functioning as the Designated Planning Agency under Section 1122 of Public Law 92603, the Social Security Amendments of 1972.
1023 State Licensing and Federal Certification as used throughout these principles are the "Regulations Governing the Licensing and Functioning of Intermediate Care Facilities for Individuals with Intellectual Disabilities " and the Federal Certification requirements for Intermediate Care Facilities for Individuals with Intellectual Disabilities that are in effect at the time the expense is incurred.
1030 REIMBURSEMENT METHOD
The Department will reimburse an ICF-IID on the basis of a prospectively determined rate on cost reporting forms provided by the Department (See Section 7000 Prospective Method of Payment for details of the Prospective Reimbursement System).
All longterm care facilities are required to submit annual cost reports as prescribed herein to the State of Maine Department of Health and Human Services, Office of Audit, 11 State House Station, Augusta, Maine 04333-0011. Such cost reports shall be based on the fiscal year of the facility.
1040 ALLOWABLITY OF COSTS
A determination of whether or not a cost is allowable and interpretations of definitions, not specifically detailed in these Principles, will be based on; first the Medicare Provider Reimbursement Manual (CMS Pub 15) guidelines and then on Internal Revenue Service guidelines in effect at the time of such determination.
[…] The section continues on maine.gov.
Every change on record in MaineCare Section 50
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