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-67-38 - INTENSIVE REHABILITATION NF SERVICES FOR INDIVIDUALS WITH ACQUIRED BRAIN INJURY (ABI)

Current through 2024-29, July 17, 2024
It has been determined that the reasonable cost of
						comprehensive rehabilitative services of acquired brain injury is an allowable
						cost. This requires that the facility possess characteristics, both in terms of
						staffing and physical design, which meet the requirements of providing
						comprehensive rehabilitative ABI services. The Department will require that the
						facility obtain prior approval of its staffing pattern for the nursing and
						clinical staff associated with the ABI unit 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/reimbursement rate.
The Department will recognize NF-ABI services when they
						are a distinct part of a dual licensed nursing facility. The facility will be
						reimbursed for the average annual per diem cost for ABI rehabilitative
						services, for individuals classified as eligible for ABI services in accordance
						with Chapter II, Section
						67 of the
MaineCare
						Benefits Manual
. There can be no duplication of services with other
						providers if clinical and therapy services are included in the facility's
						staffing/reimbursement rate.
38.1
Principle
. A nursing facility which has a recognized ABI unit will
					 be reimbursed for services provided to members covered under MaineCare 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.
38.2
Cost
. The Department's payments made for allowable ABI services
					 provided will be based on the actual cost of services provided. The allowable
					 per diem cost for ABI services will include a direct care price, a routine
					 service component, a rehabilitative ancillary service component, and a fixed
					 cost component.
38.2.1 The direct care price
					 will be determined by the Office of MaineCare Services. It will be increased
					 annually by the rate of inflation, as defined in Principle 31, at the beginning
					 of a facility's fiscal year. This direct care price is not subject to audit.
					 The Direct Care price times the number of Acquired Brain Injury days of service
					 will be removed from the total Direct Care Cost in determining the allowable
					 cost for the NF level of care.
38.2.2 The Routine Cost component rate will
					 be increased annually by the rate of inflation, as defined in Principle 31, at
					 the beginning of a facility's fiscal year.
These routine costs will be cost settled on an annual
						basis at the end of the facility's fiscal year. They will be based on actual
						costs allocated to Acquired Brain Injury services in accordance with the
						allocations defined in Principle 7.10 of these Principles.
38.2.3 Rehabilitative ancillary services
					 included in the care of an individual with brain injured residing in a
					 recognized ABI unit shall be considered an allowable cost.
Covered ancillary services must meet the requirements and
						definitions under Medicare regulations. These rehabilitative costs will be
						increased annually by the rate of inflation, as defined in Principle 31, at the
						beginning of a facility's fiscal year. These costs will be cost settled on an
						annual basis at the end of the facility's fiscal year. They will be based on
						actual costs allocated to Brain Injury services in accordance will the
						allocations defined in Principle 7.10 of these Principles.
38.2.4
Fixed Costs
. Fixed Costs
					 are an allowable cost as defined in Principle 18 of these Principles. These
					 costs will be cost settled on an annual basis at the end of the facility's
					 fiscal year. They will be based on actual costs allocated to Acquired Brain
					 Injury services in accordance will the allocations defined in Principle 7.10 of
					 these Principles.