COVID-19 Long Term Care Supplemental Payment Information for Section 2, 67, and 97 Appendix C Providers 

Apr 27, 2023

Pursuant to PL 2023, ch. 3, and as announced in a press release from Governor Mills today, the Department of Health and Human Services will be issuing $25 million in state and federal funds in supplemental COVID-19 payments to in-state Nursing Facilities (NFs), PNMI Appendix Cs (Residential Care Facilities, or RCFs), and Adult Family Care Homes (AFCHs).  

Facilities that were operational and serving clients as of March 1, 2023, will receive this COVID-19 supplemental payment. The Department issued payments to all facilities in single lump sum amounts on April 26, 2023. The date of receipt depends on individual provider payment formats and bank arrangements. The payments will be included as part of this week’s payment cycle and will be indicated as an “OTHER” payment on the Summary page of the paper remittance advice (RA) and as an invoice number beginning with “LTC” on the 835. 

METHODOLOGY

These funds have been distributed proportionally based on each facility type’s Calendar Year (CY) 2019 MaineCare revenue for these services. This will result in NFs receiving approximately 75% of the $25 million, RCFs approximately 23%, and AFCHs approximately 2%. 

For NFs and RCFs: Within the allocations for each facility type:

• 70% is distributed proportional to each facility’s CY2019 MaineCare revenue for these services, 
• 25% is allocated proportional to the facility’s most recent total vacant MaineCare bed days between November and December of 2022 for NFs and February and March 2023 for RCFs, and
• 5% is allocated proportional to facility spending on contract labor, using the most recent available MaineCare portion of 2021 over 2020 costs.

The revenue-based, MaineCare vacancy, and contract labor components were then added up for each site, and payments to the pay-to provider were summed, as applicable, across sites, regardless of provider type. 

Multi-level facilities should contact Bruce Cosgrove to determine their total payment amount per facility type. 

For AFCHs: allocations are based on revenue only as vacancy and contract labor information is not available. 

For facilities of any type without a full year of CY2019 MaineCare reimbursement data, the Department used revenue from an alternate, more recent 12-month period to determine distribution of the supplemental payment amounts by facility. For changes in ownership during this time period, the Department used CY2019 MaineCare revenue for the facility under its previous ownership status. 

AUDIT 

Use of Funds. These supplemental payments must be used to offset costs related to the COVID-19 pandemic, including costs directly related to COVID-19 (e.g., testing and personal protective equipment (PPE)), and costs indirectly stemming from the pandemic (e.g., costs related to the workforce shortage and higher energy and food costs). A cost not explicitly listed in this guidance may also be eligible, so long as the organization documents how the cost has been affected by the pandemic.  

Bonus payments at Nursing Facilities. The MaineCare Benefits Manual, Chapter III, Section 67 requires that bonuses are provided under a written policy of the provider and are related to measurable and attainable job performance expectations. Therefore, if a provider plans to implement a recruitment and/or retention bonus, they need to create a brief written policy that outlines the rationale, performance basis, and amount of the bonus.   

The eligibility period for use of these funds is July 1, 2022, to June 30, 2024. Expenses already paid for by other funding cannot be claimed against these funds.  

Cost Settlement. NFs and PNMI Appendix C, only: The supplemental payment will be reconciled at the same time as the provider’s annual cost report audit. The reconciliation of the supplemental payment and the audit of the cost report will be done separately. Providers will need to submit a financial reconciliation (Schedule GG) to the DHHS-Division of Audit with their cost report filing. The financial reconciliation must document the actual costs incurred related to the COVID-19 pandemic compared to the supplemental payments received. The Department will review the submissions for reasonableness and necessity of the expenditures and settle on any under/overpayment. For cost report filings, any expenditures paid by the supplemental payment should be removed through a cost report adjustment. 

To assist in the settlement of the supplemental payment, facilities should track their pandemic-related expenditures and funding sources, including all federal sources, and maintain complete supporting documentation for these funds. 

QUESTIONS 

For questions regarding these payments and allowable uses of funds, please see the Supplemental Payment FAQs for Sections 2, 67, 97 (Appendix C) , updated on April 27, 2023. For any additional questions, please contact your Provider Relations specialist Bruce Cosgrove. 

If you have any questions regarding cost settlement, please contact Trisha White with the Division of Audit at DHHS.Audit@maine.gov with “COVID-19 LTC Supplemental Payment Question” in the subject line or call the Division of Audit main line at 207-287-2403.