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 144-115-34 - METHOD OF PAYMENT

Current through 2024-29, July 17, 2024
34.1
Per Diem
				Costs
34.1.1
For DHHS Licensed
				Facilities-Appendix C
(Other than Adult Intellectual Disability
				Facilities):
Principle. Payment of routine services costs will be made
				  prospectively by the Department using audited 1998 costs (as filed or pro forma
				  costs used in rate setting for new facilities) as a base year, inflated by the
				  DRI index to July 1, 2001. The Department will set the routine services per
				  diem for each facility at the lesser of the facility-specific inflated base
				  year rate or the upper limit, whichever is less, and as of July 1, 2004, will
				  reduce this amount by twenty-fivecent (25¢) per diem. This becomes the
				  facility-specific cap. Providers will be reimbursed for the average annual per
				  diem cost for routine services up to the facility-specific cap. The average
				  annual per diem cost for routine multiplied by bed days of care provided to
				  members will determine reimbursement. Routine costs will be off set by the
				  program allowance paid by the MaineCare program in accordance with Section
				  33.
Effective July 1, 2001, the Commissioner of DHHS has set the
				  gross upper limit on routine costs per day at twenty-four dollars and
				  ninety-five cents ($24.95) for facilities with twenty-four (24) or fewer beds,
				  twenty-eight dollars and fifteen cents ($28.15) for facilities with twenty-five
				  (25) or more beds, and thirty-two dollars and seventy cents ($32.70) for
				  specialty Alzheimer's facilities. This will be offset by the program allowance.
				  For facilities that receive MaineCare payments for medical and remedial
				  services under Section 97, Chapters II and III, Appendix C of the MBM, the
				  Department may approve routine costs in excess of these amounts upon
				  justification by the provider. In that event, the approved costs become the
				  facility-specific caps, and the facility will not be subject to the upper limit
				  contained in Section 34.1.1. In either event, as of July 1, 2004, the
				  Department will reduce that amount by twenty-five cent (25¢) per
				  diem.
34.1.2
For DHHS
				Licensed Facilities-Appendix F-Office of Aging and Disability Services
Effective July 1, 2001, DHHS Aging and Disability Services
				  has set the upper limit on routine per diem costs at fourteen dollars and six
				  cents ($14.06). This is the net after the program allowance has been offset.
				  Subsequent to that date, the upper limit will be adjusted annually to reflect
				  the DRI index. For facilities funded by DHHS Aging and Disability Services,
				  costs will be set prospectively using audited FY 1996 costs, removing medical
				  supplies, inflated by the DRI index for FY 2001. Routine costs will be offset
				  by the program allowance paid by the MaineCare Program in accordance with
				  Section
				  33.