Maine Network Adequacy Guidance for Plan Year 2027

ME Insurance Bulletins

Published March 12th, 2026

Detected March 19th, 2026

Summary

The Maine Bureau of Insurance has issued updated Network Adequacy Guidance for plan year 2027, superseding Bulletin 487. Insurers offering Qualified Health Plans must continue to meet CMS network adequacy standards, including specific provider-to-enrollee ratios and accessibility standards, with modifications for Maine's specific conditions.

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What changed

The Maine Bureau of Insurance has released Bulletin 492, providing updated Network Adequacy Guidance for plan year 2027, which supersedes Bulletin 487. This guidance requires insurers offering Qualified Health Plans (QHPs) to adhere to network adequacy standards developed by CMS, mirroring those used in Maine for plan year 2026. Key requirements include contracting with sufficient providers to ensure at least 90% of enrollees in each county can access care within specified travel times and distances, and maintaining a primary care provider ratio of at least one full-time-equivalent provider per 2,000 enrollees. Modifications to CMS baseline standards for specific provider/county combinations due to local limitations are detailed in Appendix 1.

Insurers must submit their network templates via SERFF and any exception requests using the simplified form attached as Appendix 2, which requires a brief explanation for non-compliance. Failure to provide this explanation when a deficiency is identified will necessitate submission of the form. The guidance emphasizes adherence to CMS's geographic distance methodology for measurements and specifies that primary care providers include general and internal medicine, family practice, and pediatric providers for ratio calculations. This guidance is critical for ensuring patient access to care and compliance with state and federal regulations for health plans offered on the Marketplace.

What to do next

Review Maine Bureau of Insurance Bulletin 492 for updated network adequacy standards for plan year 2027.
Ensure contracted providers and facilities meet the specified accessibility standards (travel time, distance) for at least 90% of enrollees per county.
Verify the primary care provider to enrollee ratio meets the 1:2000 standard.
Submit network templates via SERFF and any necessary exception requests using the provided form by the relevant deadlines.

Source document (simplified)

STATE OF MAINE DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATION BUREAU OF INSURANCE Office Location: 76 Northern Avenue, Gardiner, Maine 04345 Mailing Address: 34 State House Station, Augusta, Maine 04333 www.maine.gov/pfr/insurance Phone: (207) 624-8475 TTY: Please Call Maine Relay 711 Consumer Assistance: 1-800-300-5000 Fax: (207) 624-8599 Janet T. Mills Governor Robert L. Carey Superintendent Joan F. Cohen Commissioner Bulletin 492 (Supersedes Bulletin 487) Network Adequacy Guidance for Plan Year 2027 Bureau of Insurance Rule Chapter 850 requires the Bureau to establish network adequacy standards that are equal to or exceed the minimum requirements set by the Centers for Medicare and Medicaid Services (CMS) for qualified health plans offered on the Marketplace. The Rule also requires the establishment of an exception process. The draft federal Notice of Benefit and Payment Parameters for 2027, issued on February 11, 2026, proposes to replace the time and distance network adequacy standards for state-based marketplaces with a reasonableness standard that ensures that all services will be accessible without unreasonable delay, but also allows state-based marketplaces to continue using the prior time and distance standards. For plan year beginning on or after January 1, 2027, the Bureau requires insurers offering a Qualified Health Plan (QHP) to meet the network adequacy standards developed by CMS and used in Maine for plan year 2026. To meet these standards, insurers must contract with a sufficient number of providers and facilities to ensure that at least 90 percent of enrollees in each county can access care within the specified travel time and distance standards shown in Appendix 1. CMS’ baseline standards have been modified in Maine for certain provider/county combinations where CMS has determined that its baseline standards are not achievable due to provider shortages, topographical challenges, or other limitations outside a carrier’s control. Areas where these modifications have been made are highlighted in Appendix 1. Distance and estimated driving time must be measured according to CMS’ “geographic distance” methodology, which uses an algorithm to identify the most likely driving route, considering various topographic factors that consumers experience when traveling to access care. Major medical carriers must also continue to meet Rule 850’s requirement to maintain a ratio of at least one full-time-equivalent primary care provider for every 2,000 enrollees. For purposes of 02-031 C.M.R. Rule 850 § 7(B)(2). Bureau of Insurance Bulletin 487. CMS 2026 Final Letter to Issuers in the Federally-facilitated Exchanges, Page 14. 02-031 C.M.R. Ch. 850, § 7(B)(1).

Page 2 of 2 Office Location: 76 Northern Avenue, Gardiner, Maine 04345 Mailing Address: 34 State House Station, Augusta, Maine 04333 www.maine.gov/pfr/insurance Phone: (207) 624-8475 TTY: Please Call Maine Relay 711 Consumer Assistance: 1-800-300-5000 Fax: (207) 624-8599 this calculation, primary care providers include general and internal medicine, family practice, and pediatric providers. How to Submit Network Adequacy Plans and Exception Requests The Bureau requests that carriers submit their network templates through the Systems for Electronic Rates and Form Filings (SERFF). If different plans offered by a carrier use the same network of providers, carriers should not submit more than one network file. Please do not provide a separate template for dental benefits. The Network Adequacy Exception Request Form is attached to this bulletin as Appendix 2. For plan year 2027, the form has been simplified to require that carriers briefly explain why they are unable to meet network adequacy standards, if that is the case. If a carrier has not submitted this explanation and a determination is made that a particular provider category or county does not meet network adequacy standards, the carrier will be required to submit the form with the explanation. Schedule for Template Submission The Bureau adopts CMS’ template submission schedule for Plan Year 2027: Initial Data Submission Deadline June 5, 2026 Second Data Submission Deadline (optional) July 15, 2026 Final Data Submission Deadline August 14, 2026 The Bureau will conduct reviews of the submitted templates with its vendor -- Quest Analytics, LLC -- following the initial submission deadline. The Bureau intends to notify carriers if their network(s) do not meet adequacy standards in the weeks following. Submission of a secondary template is at the discretion of the carrier and not required. Carriers should be prepared to submit a final template no later than August 14, 2026. March 12, 2026 Robert L. Carey Superintendent of Insurance Id. CMS Key Dates for Calendar Year 2026: Qualified Health Plan (QHP) Data Submission and Certification; Rate Review; and Risk Adjustment.

Appendix 1 PY2027 Maine Network Adequacy Time and Distance Standards CountySSA County FIPS State PY26 County Class Name 20000 23001 ME Metro 20010 23003 Aroostook ME Micro 20020 23005 ME Metro 20030 23007 Franklin ME Rural 20040 23009 Hancock ME Micro 20050 23011 Kennebec ME Metro 20060 23013 Knox ME Micro 20070 23015 Lincoln ME Micro 20080 23017 Oxford ME Micro 20090 23019 Penobscot ME Micro 20100 23021 ME CEAC 20110 23023 Sagadahoc ME Micro 20120 23025 Somerset ME Micro 20130 23027 Waldo ME Micro 20140 23029 ME Rural 20150 23031 York ME Metro The salmon-shaded cells on the following pages represent provider type / county combinations where Maine uses alternative standards rather than the baseline standards.

Allergy and Immunology Cardiology Cardiothoracic Surgery Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Chiropractor Dental Dermatology Distance (Miles) Time (Minutes) DEN Distance (Miles) DEN Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Emergency Medicine Endocrinology ENT/Otolaryngology Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York

Gastroenterology General Surgery Gynecology (OB/GYN) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Infectious Diseases Nephrology Neurology Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Neurosurgery Occupational Therapy Oncology - Medical & Surgical Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York

Oncology - Radiation Ophthalmology Orthopedic Surgery Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Outpatient Clinical Behavioral Health Physical Medicine & Rehabilitation Physical Therapy OPBH Distance (Miles) OPBH Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Plastic Surgery Podiatry Primary Care - Adult Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) PCX Distance (Miles) PCX Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York

Primary Care - Pediatric Psychiatry Pulmonology Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Rheumatology Speech Therapy Urology Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Vascular Surgery Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York The salmon-shaded cells represent the alternative times and distances for the respective individual provider specialty type / county combinations.

Facility Provider Specialty Types Acute Inpatient Hospitals (Must have emergency services available 24/7) Cardiac Catheterization Services Cardiac Surgery Program Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Critical Care Services - Intensive Care Units (ICU) Diagnostic Radiology (Free-standing; hospital outpatient; ambulatory health facilities with Dx Radiology) Inpatient or Residential Behavioral Health Facility Services Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) MHF Distance (Miles) MHF Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York Mammography Outpatient Infusion/ Chemotherapy Skilled Nursing Facilities Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York

Surgical Services (Ambulatory Surgical Centers and Outpatient Hospital) Urgent Care Distance (Miles) Time (Minutes) Distance (Miles) Time (Minutes) Aroostook Franklin Hancock Kennebec Knox Lincoln Oxford Penobscot Sagadahoc Somerset Waldo York The salmon-shaded cells represent the alternative times and distances for the respective facility provider specialty type / county combination Facility Provider Specialty Types

Carriers that cannot comply with the provider time and distance standards established in the Maine Bureau of Insurance’s annual network adequacy bulletin, issued pursuant to Rule 850 § 7(B)(2), may request an exception to these requirements. Carrier Information Company Name Address City State Zip Contact Name Contact Phone Number Email Please provide a brief statement explaining why the carrier cannot meet the distance and travel time standards specified in Appendix 1 to ensure that at least 90% of enrollees in that particular county can access care: Appendix 2 Network Adequacy Exception Request Form