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-E - COMMUNITY RESIDENCES FOR PERSONS WITH MENTAL ILLNESS › Section 144-101-III-97-E-6000 - RATE-SETTING

Current through 2024-29, July 17, 2024
6000.1 Payment rates and the total cost cap
						are established prospectively by the OMS and Department for each facility based
						on approved budgeted costs for the provider's fiscal year. The approved
						facility budget is based on a rate setting report submitted to the OMS and
						Department by the provider prior to the beginning of the provider's fiscal
						year. The budget shall be submitted on forms/media prescribed by the OMS and
						Department.
6000.2 The provider
						must also submit, upon request, such data, statistics, schedules, or other
						information that the OMS and Department requires.
6000.3 The rate for the previous period will
						remain in effect until a new rate is approved. Retroactive rate adjustments
						shall not be granted, unless approved by the OMS and Department under
						exceptional circumstances as determined by these two agencies.
6000.4 The new rate will be effective for
						services provided from the first day of the month following the OMS and budget
						approval from the Department.
6000.5 Providers must submit a rate setting
						report and any required supporting documentation for each facility at least 60
						days prior to the start of the provider's fiscal year. The inclusive dates of
						the rate setting period shall be the inclusive dates of the cost reporting
						period as described by Chapter III, Section 3300.3.
6000.6 The OMS and Department may issue
						guidelines to assist providers in developing their budgets for the agreement
						period.
6000.7 The total allowable
						costs for the budget period, based on prior year actual allowable costs,
						current year costs and funding levels, and pre approved changes expected in the
						budget period, as reported by the provider, are used to determine the level of
						reasonable costs to be recognized in setting the prospective rate and total
						cost cap for the budget period. Only costs that are allowable pursuant to
						Section
						2400 are included in
						calculating the prospective rate.
6000.8 Approval of the prospective rate and
						the total cost cap is at the discretion of the OMS and Department. The OMS and
						Department may make adjustments modifying the provider's proposal.
6000.9 Calculation of the prospective rate:
						the total cost cap shall be divided by the estimated annual occupancy.
6000.10 Providers must ensure that
						the increase in reimbursement rates effective August 1, 2018 is applied in full
						to wages and benefits for employees who provide direct services. Providers must
						document compliance with this requirement in their financial records and
						provide such documentation upon request. The increase must be granted or paid
						out retroactively from the date the Department begins reimbursing the increased
						rates.