MaineCare Notice of Agency Emergency Rule-making Adoption, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
Notice of Agency Emergency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE:
10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
EMERGENCY RULE
The Department of Health and Human Services adopts these emergency rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services.
The Department’s principal purpose of this emergency rulemaking is to establish new reimbursement methodology for Acute Care and Rehabilitation Hospitals, with the exception of Distinct Psychiatric and Substance Use Disorder Unit services for which the Department recently implemented a new reimbursement methodology.
In compliance with 22 M.R.S. Sec. 3173-J(2), the Department conducted a rate determination process: a Rate Determination Initiation Notice was issued on June 23, 2023. MaineCare presented the draft reimbursement methodology and definitions to providers and interested stakeholders on December 11, 2023; February 16, 2024; and June 11, 2024. The Department accepted public comments through June 25, 2024 and responded in writing to comments with an explanation of whether and how feedback was incorporated into the final reimbursement methodology and rates.
These changes include improved alignment with Medicare, greater consistency in reimbursement methodology across hospitals, and ensuring that reimbursement for services better reflects patient acuity. The Department adopts methodology which aligns reimbursement for facilities with similar delivery systems and cost structures, recognizing three distinct hospital peer groups that recognize distinct Maine Base Rates for inpatient services: Acute Care Non-Critical Access, Non-State Government Owned, and Rehabilitation. The Department’s updated methodology introduces mechanisms to keep pace with inflation and improve the relationship between the quality of service outcomes and payment.
The Department shall submit to the Centers for Medicare & Medicaid Services, and anticipates approval, for State Plan Amendments related to these provisions.
Some of the rule changes have a retroactive application date of July 1, 2024, and the rule indicates the July 1, 2024 effective date for those provisions. The Department certifies that the retroactive changes comply with, and thus are authorized by, 22 M.R.S. Sec. 42(8).
Findings of Emergency:
The Maine Legislature granted the Department of Health and Human Services authority to adopt emergency rules under 5 M.R.S. Sec. 8054, if determined necessary by the Department to implement those provision of the Supplemental Budget Act over which the Department has subject matter jurisdiction, without the requirement that it demonstrate that immediate adoption is necessary to avoid a threat to public health, safety or general welfare. P.L. 2023, ch. 643, PART VV, Sec. VV-1. The Department has determined that it is necessary to adopt this emergency rule to implement provisions of the Supplemental Budget Act regarding hospital reimbursement set forth in PART A, Sec. A-14.
Pursuant to 5 M.R.S §8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: August 9, 2024
STATUTORY AUTHORITY: 5 M.R.S. § 8054; 22 M.R.S. §§ 42, 3173-J; P.L. 2023, ch. 643.
AGENCY CONTACT PERSON: Julieanna Scott, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
EMAIL: julieanna.scott@maine.gov
TELEPHONE:207-287-2286 FAX: (207) 287-6106
TTY: 711 (Deaf or Hard of Hearing)
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