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-107 - Principles of Reimbursement for Psychiatric Residential Treatment Facility Services › Subsection 144-101-III-107-1 - GENERAL PROVISIONS

Current through 2024-29, July 17, 2024
1.1
PURPOSE
The purpose of these principles is to comply with
						42
						U.S.C. §§
													1396d(a)(16) and
						(h)42 CFR §441.150 through §441.184
						and
						42 CFR §
													483.350 through §
												483.376.
						These principles provide reimbursement methodology for Psychiatric Residential
						Treatment Facility (PRTF) services (provided under the MaineCare Program in
						accordance with Title XIX of the Social Security Act) through the use of rates
						which are reasonable and adequate to meet the costs of the facility. These
						costs must be incurred by efficiently and economically operated facilities in
						order to provide care and services in conformity with applicable State and
						Federal laws, regulations, and quality and safety standards. Accordingly, these
						rates take into account the costs of services required to attain or maintain
						the highest practicable physical, psychological, and psychosocial well-being of
						each MaineCare resident.
1.2
AUTHORITY
The Authority of the Department to accept and administer
						any funds which may be available from private, local, State or Federal sources
						for the provision of the services set forth in the Principles of Reimbursement
						is established in Title 22 of the Maine Revised Statutes Annotated. The
						regulations themselves are issued pursuant to authority granted to the
						Department by Title 22 of the Maine Revised Statutes Annotated §§41-B
						and 42(1).
1.3
GENERAL
					 DESCRIPTION OF THE RATE SETTING SYSTEM
Providers of PRTF services are paid a statewide per diem
						rate for medical, clinical and direct care costs (direct care services), and
						paid a facility-specific rate for routine and fixed costs (room and board
						costs). The routine and fixed costs facility rate is informed by annual cost
						reporting performed by the providers using a state-developed cost report. The
						medical, clinical and direct care per diem rate is not cost settled. The
						routine and fixed cost rate is cost settled by the Department.
(A) Routine and Fixed Costs: An interim
					 payment system for psychiatric residential treatment facilities (PRTF) is
					 established by these rules in which the payment rate for services is set in
					 advance of the actual provision of those services. A facility's cost report is
					 reviewed to extract those costs that are allowable costs. A facility's costs
					 may fall into an allowable cost category, but be determined unallowable because
					 they exceed certain limitations. Once allowable costs have been determined they
					 will be separated into two (2) components - routine and fixed costs, resulting
					 in one cost settled interim rate for room and board.
(B)
Medical, Clinical, and Direct Care
					 Costs
: Medical, Clinical, and Direct Care costs are reimbursed at a Per
					 Diem rate. The per diem rate is a statewide rate and it is not subject to cost
					 settlement.