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-F - NON-CASE MIXED MEDICAL AND REMEDIAL SERVICES FACILITIES › Section 144-101-III-97-F-1000 - INTRODUCTION

Current through 2024-29, July 17, 2024
1010
Purpose
. The purpose of
						this Appendix is to define the payment mechanism for Title XIX funds in medical
						and remedial services facilities under Section 97, Chapter II, Private
						Non-Medical Institution (hereinafter PNMI) Services of the
MaineCare
						Benefits Manual
, that are exempt from Appendix C. It shall be the
						prerogative of the Commissioner of the Department of Health and Human Services
						to impose a ceiling on all or a portion of reimbursement for PNMIs provided by
						their Departments. These regulations identify those costs that are covered
						under this Section and the method of payment.
1020
Authority
. The authority of
						the Maine Department of Health and Human Services to accept and administer
						funds that may be available from private, local, State, or Federal sources for
						the provision of services set forth in this Appendix is established in Title 22
						of the
Maine Revised Statutes Annotated
, §3, §10,
						§42, §3273. The Department of Health and Human Services issues these
						regulations pursuant to authority granted by Title 22 of the
Maine
						Revised Statutes Annotated
§42(1).
1030
Principle
. In order to
						receive reimbursement according to this Appendix, a facility must be licensed
						as a residential care facility and have a provider contract specifying the
						conditions of participation in Title XIX as a Private Non-Medical Institution
						as described in Section 97, Chapter II of the
MaineCare Benefits
						Manual
. Scattered site facilities for persons with intellectual
						disabilities may be licensed either as a residential care facility or as a
						mental health provider in accordance with The Mental Health Agency Licensing
						Standards and Rights of Recipients of Mental Health Services, Regulations for
						Licensing and Certification of Alcohol and Drug Treatment Services."
						Determination of resident eligibility is made according to Chapter II, Section
						97 of the
MaineCare Benefits Manual
. Residents who are 18-64
						years of age and living in Institutions for Mental Diseases are not eligible
						under this Appendix. However, the cost of covered services to residents of
						Institutions for Mental Diseases who are 65 years of age or older can be
						claimed under this Appendix provided they meet all other requirements for
						eligibility.
The Department will make payment for any eligible
						  member only if the provider obtains the signature of a physician prescribing
						  covered services prior to the first date of service. The provider must maintain
						  this information as part of the member's record.
The Department will not make payment for residents who
						  are family members of the owner or provider staff providing medical and
						  remedial services.
1040
Scope
. Level 1 Residential Care Facilities that provide custodial
						(e.g. supervision, medication administration, and room and board) services to
						six or fewer residents and do not provide individualized in-home programming to
						persons with severe physical or functional disability are not eligible for
						payment under this Appendix. These facilities are paid on a flat rate
						basis.