Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 115 - PRINCIPLES OF REIMBURSEMENT FOR RESIDENTIAL CARE FACILITIES - ROOM AND BOARD COSTS › Section 144-115-14 - REIMBURSEMENT METHOD

Current through 2024-29, July 17, 2024
14.1 All facilities
				must be appropriately licensed by the Division of Licensing and Certification
				and have signed a Provider/Supplier Agreement with DHHS, Office of MaineCare
				Services, in order to be reimbursed.
14.2 Subject to the availability of funds,
				the Department will reimburse Appendix C and F, Level III and Level IV Private
				Non-Medical Institutions (PNMI) facilities defined under the MBM, Chapter III,
				Section 97, Appendix C and F for allowable room and board costs as defined in
				this Chapter.
14.3 Residential care
				facilities will be reimbursed for allowable room and board costs provided to
				eligible members based on an interim rate established by the Department. The
				Department will establish an interim rate based on what it determines is
				reasonable and adequate to meet the costs which must be incurred by an
				efficiently and economically operated facility in conformity with applicable
				State and Federal laws, regulations and quality and safety standards.
14.3.1 The Department will furnish blank cost
				reports to the facilities for their use. The facility's financial statements
				will be the basis for completing the cost report and establishing an interim
				rate of reimbursement.
14.3.2
				Facilities are required to submit annual cost reports as stated in Section
				18.4.
14.3.3 Written requests for
				interpretation of these Principles will be responded to in writing by the
				Department, and copies of these interpretation letters will be available to all
				interested parties.
14.3.4 In
				facilities licensed for nursing and residential care, the cost finding method
				contained in Section 18.3 of these Principles applies. All other Principles
				pertaining to the treatment of costs in these rules will also apply.
				Multi-level facilities must use the nursing facility cost report
				form.
14.3.5 The Department
				reserves the right to take legal action against, and/or terminate the MaineCare
				Provider/Supplier Agreement of a facility which fails to comply with these
				Principles, or which submits or causes to be submitted false information for
				the purpose of obtaining greater compensation than that to which the provider
				is legally entitled.
14.3.6 The
				failure of the Department to insist upon the performance of any of the terms or
				conditions of these Principles, or to exercise any right under these
				Principles, or to disapprove of any practice, accounting procedure or item of
				account in any audit, shall not be construed as a waiver of future performance
				of the right. The obligation of the Provider with respect to future performance
				shall continue, and the Department shall not be prevented from requiring such
				future performance.
14.3.7 No final
				audit shall be reopened, or any hearing allowed, concerning matters contained
				in any final audit if three (3) years following the date of the final audit
				settlement have passed. This limitation does not apply in the event of fraud or
				misrepresentation.