Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-67 - Principles of Reimbursement for Nursing Facilities › Subsection 144-101-III-67-9 - COST RELATED TO RESIDENT CARE

Current through 2024-29, July 17, 2024
9.1
Principle
. Federal law requires that payment for long term care
					 facility services provided under MaineCare shall be provided through the use of
					 rates which are reasonable and adequate to meet costs which must be 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. Costs incurred by efficiently and economically
					 operated facilities include costs which are reasonable, necessary and related
					 to resident care, subject to principles relating to specific items of revenue
					 and cost.
9.2 Costs must be
					 ordinary and necessary and proper and related to resident care. They must be of
					 the nature and magnitude that prudent and cost conscious management would pay
					 for a specific item or service.
9.3
					 Costs must not be of the type conceived for the purpose of circumventing the
					 regulations. Such costs will be disallowed under Principle 11.
9.4 Costs that relate to inefficient,
					 unnecessary or luxurious care or unnecessary or luxurious facilities or to
					 activities not common and accepted in the nursing home field are not
					 allowable.
9.5 Wages, to be
					 allowable, must be reasonable and for services that are necessary and related
					 resident care and pertinent to the operation of the facility. The services must
					 actually be performed and must be paid in full. The wages must be reported to
					 all appropriate state and federal tax authorities to the extent required by law
					 for income tax, social security, and unemployment insurance purposes. Bonuses
					 which are part of a written policy of the provider and which require some
					 measurable and attainable job performance expectation from the employee are
					 allowable. Bonuses based solely on the availability of any anticipated savings
					 in the MaineCare Direct Care Component are not allowable.
9.6 Costs which must be incurred to comply
					 with changes in federal or state laws and regulations and not specified in
					 these regulations for increased care and improved facilities which become
					 effective subsequent to December 31,1998 are to be considered reasonable and
					 necessary costs. These costs will be reimbursed as a fixed cost until the
					 Department calculates the State wide peer group mean cost of compliance from
					 the facility's fiscal year data following the fiscal year the cost was
					 originally incurred. Following the second fiscal year the facility will be
					 reimbursed the statewide average cost of compliance. The statewide average cost
					 for this regulation/law will be built into the appropriate cost component in
					 subsequent years.
9.7 Costs
					 incurred for resident services that are rendered in common to MaineCare
					 residents as well as to non-MaineCare residents, will be allowed on a pro rata
					 basis, unless there is a specific allocation defined elsewhere in these
					 Principles.
9.8 Cost to Related
					 Organizations Principle. Costs applicable to services, facilities, and supplies
					 furnished to the provider by organizations related to the provider by common
					 ownership or control are includable in the allowable costs of the provider at
					 the cost to the related organization. However, such costs must not exceed the
					 price of comparable services, facilities, or supplies that could be purchased
					 elsewhere. Providers should reference Principle 6 of these
					 Principles.