Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities
NATURE OF PROPOSED CHANGES: The Department addresses aspects of reimbursement for Nursing Facilities and Appendix C, Private Non-Medical Institutions (PNMI Cs). It seeks approvals to issue two one-time supplemental payments for facilities that provide veteran-focused care, and establish a new Department requirement for timelines related to reimbursement during the cost settlement process for all Nursing Facilities and PNMI Cs.
The first supplemental payments will be issued to nursing facility providers that provide comprehensive care to MaineCare veterans to meet their unique needs. This payment will total $8,896,077. In order to receive payment, a nursing facility must meet the following criteria:
1. The facility provides critical access to veteran-focused care, including specialized training and care of war-related injuries and conditions, such as Post Traumatic Stress Disorder (PTSD) and service-connected disabilities;
2. The nursing facility is subject to Department of Veterans Affairs (VA) regulations, oversight, and reporting requirements;
3. The nursing facility board of directors is appointed by the governor; and
4. The nursing facility participates in the Maine Public Employees Retirement System.
The second supplemental payment will total $3,028,707 and will be issued to certain Private Non-Medical Institution (PNMI) providers delivering services through Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities. Eligible providers provide comprehensive care to MaineCare veterans to meet their unique needs, including critical access to veteran-focused care, including specialized training and care of war-related injuries and conditions, such as Post Traumatic Stress Disorder (PTSD) and service-connected disabilities.
Additionally, this amendment adds a requirement that the Department reimburse at least 75% of the as-filed settlement pursuant to a facility's cost reports within 90 days of receipt in accordance with the requirements established within Maine P.L. 2023 ch. 121 Resolve, Directing the Department of Health and Human Services to Expedite Reimbursement of Long-term Care Facilities.
REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2023, ch. 643, An Act to Make Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and to Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2024 and June 30, 2025 and Maine P.L. 2023 ch. 121 Resolve, Directing the Department of Health and Human Services to Expedite Reimbursement of Long-term Care Facilities.
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will be cost $11,924,784 in federal fiscal year 2025 which includes $7,410,715 in federal funds and $4,514,069 in state funds.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location.
CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE:(207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
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