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 › Subsection 144-101-III-21-1500 - AVERAGE BILLING METHOD

Current through 2024-29, July 17, 2024
When billing, the Home Support Agency per diem services
						  providers may choose to bill for services provided using the weekly billing
						  method or the monthly average billing method.
Weekly Billing Method
- Providers bill at
						  the end of each week based on the actual number of hours of direct support
						  provided in comparison to the hours authorized. If the actual total weekly
						  direct support hours provided for the facility falls within the range of
						  allowable total weekly authorized support hours for the facility then the
						  facility bills at the authorized per diem rate.
If the actual total weekly direct support hours
						  provided for the facility is
less than
the range of
						  allowable total weekly authorized support hours for the facility then the
						  billable rate is determined by using the actual weekly total support hours
						  provided for the facility. Providers may refer to the billable rate under the
						  applicable table on
http://www.maine.gov/dhhs/oads/disability/ds/MaineCare/index.shtml
or use Appendix IIA or IIB to calculate the billable amount.
Monthly Average Billing Method
- Providers
						  may calculate a monthly average of weekly direct support services hours
						  provided at the end of each month. If a provider chooses to use the monthly
						  average billing method then all days in the month must be billed using this
						  method. To use this method a provider must submit claims after the last day of
						  the month.
To determine the actual total weekly direct support
						  hours, the actual total hours of direct support provided in the month from
						  1st day of the month through the last day of the
						  month are divided by number of weeks in the month.
A. If there are 31 days in the month, then
						the number of weeks in the month is 4.43.
B. If there are 30 days in the month, then
						the number of weeks in the month is 4.29.
C. If there are 29 days in the month, then
						the number of weeks in the month is 4.14.
D If there are 28 days in the month, then the
						number of weeks in the month is 4.00.
The result determines the average actual total weekly
						  direct support hours provided by the facility for the entire month. If the
						  average actual total weekly direct support hours provided by the facility falls
						  within the range of allowable total weekly support hours that was authorized
						  then the provider must bill at the authorized per diem rate.
If the average actual total weekly direct support hours
						  provided by the facility is
less than
the range of
						  allowable weekly support hours that was authorized then the billable rate will
						  be determined by using the actual total support hours provided for the
						  facility. Providers can determine the billable rate in the applicable table in
						  Appendix IIB in Chapter III.
Partial Week
- There are situational
						  changes, often unpredictable, that occur resulting in a change in the
						  authorized hours of support in a facility mid-week. Examples include death of a
						  member, unanticipated move or the startup of a new program mid-week.
In these instances, if the Provider has chosen to bill
						  on a monthly basis, services for the week in which the authorization change
						  occurred must be billed on pro-rated basis to determine the actual total weekly
						  support hours provided using the formula below:
If services are provided for 1 day, then the number of
						  actual hours provided is .1428.
If services are provided for 2 days, then the number of
						  actual hours provided is .2857.
If services are provided for 3 days, then the number of
						  actual hours provided is .4285.
If services are provided for 4 days, then the number of
						  actual hours provided is .5714.
If services are provided for 5 days, then the number of
						  actual hours provided is .7142.
If services are provided for 6 days, then the number of
						  actual hours provided is .8571.
Refer to the rate schedule to select the appropriate
						  rate to bill based on the hours provided.