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-67 - Principles of Reimbursement for Nursing Facilities › Subsection 144-101-III-67-39 - COMMUNITY-BASED SPECIALTY NURSING FACILITY UNITS

Current through 2024-29, July 17, 2024
Community-based specialty nursing facility units means
						providing medical-psychiatric services to former residents of the Riverview
						Psychiatric Center (formerly Augusta Mental Health Institute) and the Dorothea
						Dix Psychiatric Center (formerly Bangor Mental Health Institute (BMHI)) as well
						as other MaineCare members with qualifying mental disorders who have been
						deemed eligible by the Department or its Authorized Entity to receive these
						services. The Department shall designate specialty nursing facility units that
						provide medical-psychiatric services to former residents of the Riverview
						Psychiatric Center and the Dorothea Dix Psychiatric Center (BMHI). It has been
						determined that the reasonable cost of services for these residents, who have
						multiple medical needs that make them eligible for nursing facility level of
						care and have a primary diagnosis of mental disorder that requires the ongoing
						supervision of trained professionals, is an allowable cost. This requires the
						nursing facility unit to possess characteristics, both in terms of staffing and
						physical design, for providing services to these residents as approved, in
						writing, by the Office of Aging and Disability Services.
Such designated specialty units shall be subject to the
						provision of these rules, except for the rate limitations contained in
						Principles 22-27.
The Department will require that the facility obtain
						prior approval of its staffing pattern for the nursing and clinical staff
						associated with these facilities from the Office of MaineCare Services. In the
						event a facility believes that the needs of the residents it serves have
						increased or decreased, the facility must request prior approval from the
						Office of MaineCare Services authorizing such a change to its staffing
						pattern.
39.1
Principle
.
					 A nursing facility that is recognized as a specialty unit under this Principle
					 will be reimbursed for services provided to residents covered under the Title
					 XIX program based upon the actual cost of services provided. The Department
					 will establish the rate and determine that the cost is reasonable and adequate
					 to be an efficiently and economically operated facility in order to provide
					 care and services in conformity with applicable state and federal laws,
					 regulations, and quality and safety standards.
39.2
Cost
. The Department's
					 payments made for allowable services provided will be based on the actual
					 allowable cost of services provided to such residents. The allowable per diem
					 cost for the services will be increased annually by the rate of inflation at
					 the beginning of each facility's fiscal year based on Principle 31. This per
					 diem rate is subject to audit and will be adjusted to the actual allowable
					 costs of providing services to such residents in these units at year
					 end.
39.3
Cost
					 Reporting
. Costs will be reported in a manner that will segregate the
					 costs of such residents in the specialty unit from the costs of other residents
					 in the unit and the standard nursing facility's costs as apply under these
					 Principles.
For the purpose of calculating the reimbursement rate for
						such residents in the specialty unit, whether interim or final, a facility that
						has been designated as a specialty unit under this section of the Principles
						for a distinct part shall allocate the costs of such residents in the distinct
						part as if the distinct part were licensed as a separate level of care. All
						other sections of these Principles pertaining to the allowability, recording,
						and reporting of costs shall apply.