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-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Appendix 144-101-III-21-IIB - Weekly Hours Authorized & Billed per Facility

Current through 2024-29, July 17, 2024
APPENDIX IIB
Weekly Hours Authorized & Billed per
									 Facility
Home Support Agency per
									 diem
Provider
Location Address
MaineCare Provider ID
Authorized billable Rate
									 Calculator
MaineCare Member
Regular Support Hours up to
									 168
Hours in excess of 168
Medical Support Hours
Total Support Hours (sum total of all
									 types of support hours)
Instructions
A
Enter the weekly authorized support hours under
									 each type by MaineCare member for this facility
B
C
D
E
F
TOTAL weekly authorized support hours by
									 each type
Sum of total weekly authorized support hours
									 for all members in facility by type of support and total facility.
RANGE
The range of allowable weekly hours is based on
									 authorized hours with the lowest hours in range at 92.5% of total authorized
									 hours and the highest hours in the range at 105% of the total authorized
									 hours.
Lowest - 92.5% total weekly of Authorized
									 Hours
Highest - 105% total weekly of Authorized
									 Hours
Regular Support Hours up to 168
Hours In Excess of 168
Medical Support Hours
Hourly Support reimbursement rates by
									 type
$
32.13*
$28.74*
$
38.69*
Amount includes service provider tax
									 expense
Total Weekly Authorized amount for
									 facility by type
Total weekly authorized support hours
									 multiplied by Hourly support Rate for each type
Number of days per week
7
7
7
7
7
7
Seven days in a week
Number of members in facility(1 to
									 6)
Total number of members in facility that are
									 authorized for service. For Medical Add on, it would only be the number of
									 members in facility that are authorized for those services.
Total Authorized Per Diem (Daily) rate
									 amount
Total Weekly Authorized amount divide by number
									 of days per week and then by the number for members in the facility for each
									 type
Total amount / Days/ # of Consumers
*The Department is seeking and anticipates receiving
						  approval from the federal Centers for Medicare and Medicaid Services for these
						  changes.
Providers are responsible for calculating all amounts
						  payable to them in accordance with the above-listed rates and rate calculation
						  formula.
As an assistive tool, OMS provides sample calculations
						  for each rate based on the number of weekly service hours provided and the
						  number of members served. Providers may request paper copies of calculation
						  Appendices IIA & IIB Tables 1 & 2 are accessible through the DHHS
						  website
http://www.maine.gov/dhhs/oads/disability/ds/MaineCare/index.shtml
.
						  Providers may request paper copies of the tables by calling OMS at
1-866-690-5585. TTY 711
.
*Maximum allowance Effective 7/1/18
THE DEPARTMENT EXPRESSLY DISCLAIMS THE ACCURACY OF THE
						  CALCULATIONS TABULATED IN TABLES 1 & 2 AND EXPRESSLY DISCLAIMS ANY AND ALL
						  LIABILITY FOR LOSSES, INCURRED COSTS, OR OTHER DETRIMENT SUFFERED BY ANY
						  PROVIDER AS A RESULT OF RELIANCE UPON INFORMATION CONTAINED IN Appendix IIA or
						  IIB.
Appendix IIA is for members Authorized with Regular
						  service. Appendix IIB is for members authorized with Medical Add On
						  services.
MaineCare Member
Regular Support Rate up to
									 168
Hours in excess of 168
Medical Support Rate
A
B
C
D
E
F
MaineCare Member
Actual Regular Support Hours up to
									 168
Hours in excess of 168
Actual Medical Support
									 Hours
Actual Total Support Hours (sum total of
									 all types of support hours)
A
B
C
D
E
F
Actual support hours provided in a week by
									 Type
Range of total Authorized support
									 Hours
Hours Authorized
Lowest - 92.5% total weekly of Authorized
									 Hours
Highest - 105% total weekly of Authorized
									 Hours
If Actual weekly hours provided fails within or
									 above the range or authorized total weekly support hours than the provider
									 should bill at the authorized member Per Diem (daily) rate from above.
If Actual weekly hours provided falls below the
									 range of authorized total weekly support hours then the provider should bill
									 actual number of hours provided times the reimbursement rate. See Calculator
									 below
Regular Support Hours up to
									 168
Hours in excess of 168
Medical Support Hours
Total Actual Support Hours (sum total of
									 all types of support hours)
Actual support hours provided in a week
									 by type
Hourly Support reimbursement rates by
									 type
Total Weekly reimbursement amount for
									 facility by type
Number of days per week
7
7
7
Number of members in facility that were
									 authorized and provided service by type
Total Billable Per Diem(Daily) rate
									 Amount
(Total amount / Days) / # of Consumers