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-97 - Private Non-Medical Institution Services › Appendix 144-101-III-97-C - MEDICAL AND REMEDIAL SERVICE FACILITIES › Section 144-101-III-97-C-2400 - ALLOWABILITY OF COST

Current through 2024-29, July 17, 2024
2400.1
Case
						Mix Adjusted Price
The case mix adjusted price includes services provided
						  by the direct care services staff listed below. Allowable costs include
						  salaries, wages, benefits, and consultant fees for direct care staff and
						  services listed below:
Clinical consultant services
Licensed practical nurse services
Licensed social workers or other social worker
						  services
Personal care services staff
Practical nurses
Registered nurse consultant services, and
Other qualified medical and remedial staff.
2400.2
Program
						Allowance
A program allowance of thirty-five (35) percent,
						  expressed as a percentage of the allowable costs, as defined in Chapter III,
						  Section 97, Sections 2400.1 and 2400.2 will be allowed in lieu of indirect
						  and/or PNMI related cost.
2400.3
Personal Care Services Not
						Included in the Case Mix Adjusted Price
Effective July 1, 2002, personal care services not
						  included in the case mix adjusted price include salaries, wages, and benefits
						  (as described in Chapter III, Section 2400.2 ) for direct care staff listed
						  below:
Laundry
Housekeeping, and
Dietary services
The personal care services component is determined by
						  inflating the facility's 1998 audited costs for these services to June 30,
						  2003. This becomes the PNMI's facility specific cap. The actual allowable
						  personal care services costs will be settled at audit up to this cap.
The increases in wages and wage-related benefits set
						  forth in 2400.5 in the "Main Rule" and 2400.9 in this Section shall not be
						  included in the PNMI facility's personal care services cost caps.
2400.4
Allowable Costs
						Related to Contract Fees for Exchange Fellows
Allowable costs will also include the contract fee
						  paid for use of exchange fellows in lieu of direct service staff as defined in
						  the applicable appendix. Contract fees must be prior-approved by the seeding
						  Department. The contract fee paid cannot exceed the normal salary plus benefits
						  and taxes for comparable direct service staff within the provider
						  agency.
2400.5
State
						Mandated Service Tax
As of July 1, 2004, allowable costs shall include a
						  State-mandated service tax. The State-mandated service tax is a tax on the
						  value of PNMI services pursuant to
						  36 M.R.S.
						  §2552.
2400.6
Remote Island Supplemental
						Payment
Eligible facilities will be allowed to retain the
						  "remote island facility" supplemental payment, representing a fifteen (15)
						  percent rate increase, in addition to the total allowable rate for Private
						  Non-Medical Institution direct care services and personal care services costs
						  otherwise determined under these rules.
2400.7
Extraordinary Circumstance
						Allowance
Pending CMS approval, effective retroactive to
						  November 1, 2017, facilities which experience unforeseen and uncontrollable
						  events during a year that result in unforeseen and uncontrollable increases in
						  expenses, as defined herein, may request an adjustment to a prospective rate in
						  the form of an extraordinary circumstance allowance (ECA).
Unforeseen
means that a provider did not
						  have sufficient notice of the change to make changes to their operations that
						  would have avoided the cost of the event.
Uncontrollable
means that the event
						  occurred as a result of forces unrelated to the discretionary management
						  authority exercised by the provider's organization. Business decisions are not
						  considered uncontrollable.
ECA may include, but are not limited to:
* Events of a catastrophic nature (fire, flood,
						  etc.);
* Unforeseen increase in minimum wage, Social Security,
						  or employee retirement contribution expenses in lieu of Social Security
						  expenses;
* Change in number of licensed beds;
* Changes in licensure or accreditation
						  requirements.
If the Department concludes that an ECA existed, and
						  the increased costs are considered reasonable and necessary, an adjustment will
						  be made by the Department in the form of a supplemental allowance.
The Department will determine from the nature of the
						  ECA whether it would have a continuing impact and therefore whether the
						  allowance should be included in the computation of the base rate for the
						  succeeding year. Reimbursement to a residential care facility for additional
						  costs arising from ECA must be paid via a supplemental payment that is added to
						  the per diem reimbursement rate until the Department adjusts the direct care
						  and personal care services rates, as applicable, to fairly reimburse a facility
						  for these costs.
A request for ECA must be made in writing and
						  addressed to:
Department of Health and Human Services
Director of Rate-setting
11 State House Station
Augusta, ME 04333
The written request must include:
1. The reason(s) for the ECA
						request;
2. The dollar amount of
						the ECA request;
3. The
						expected/anticipated duration of the need for the ECA;
4. An explanation of how the ECA request is
						both unforeseen and uncontrollable; and
5. All documentation supporting the ECA
						request.
The Department may require additional documentation to
						  review and process the ECA request. A facility requesting an ECA shall provide
						  all documents requested by the Department. The Department shall deny any ECA
						  requests from facilities who refuse to supply requested documentation.