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-97 - Private Non-Medical Institution Services › Subsection 144-101-III-97-9000 - GENERAL DEFINITIONS

Current through 2024-29, July 17, 2024
"Accrual Basis of Accounting"
means that
						revenue is reported in the period when it is earned, regardless of when it is
						collected, and expenses are reported in the period in which they are incurred,
						regardless of when they are paid.
"Allowable Costs"
are those operating costs
						remaining after the adjustments required by the Principles have been applied to
						the provider's total operating costs reported in the annual cost
						reports.
"Cash Basis of Accounting"
means revenues
						are recognized only when cash is received and expenditures for expense and
						asset items are not recorded until cash is disbursed for them.
"Census/Days of Care":
For purposes of
						counting the number of patient days, the day of the patient's admission will be
						counted, but the day of discharge will not be counted.
"Centers for Medicare and Medicaid Services (CMS)
						(formerly the Health Care Financing Administration (HCFA)"
is the Agency
						within the U.S. Department of Health and Human Services (HHS) responsible for
						developing and implementing policies governing the Medicare and federal
						Medicaid programs.
"Common Ownership"
exists if an individual
						or individuals possess 10% or more ownership or equity in the provider and the
						institution or organization serving the provider.
"Control"
exists if an individual or an
						organization has the power, directly or indirectly, to significantly influence
						or direct the actions or policies of an organization or institution.
"Cost Finding"
are the processes of
						segregating costs by cost centers and allocating indirect cost to determine the
						cost of services provided.
"Days of Care"
are total days of care
						provided whether or not payment is received and the number of any other days
						for which payment is received. (Note: Discharge days are included only if
						payment is received for these days.)
"Generally Accepted Accounting Principles
						(GAAP)"
are those accounting principles with substantial authoritative
						support. In order of authority the following documents are considered GAAP:
(1) FASB Standards and
					 Interpretations,
(2) APB Opinions
					 and Interpretations,
(3) CAP
					 Accounting Research Bulletins,
(4)
					 AICPA Statements of Position,
(5)
					 AICPA Industry Accounting and Auditing Guides,
(6) FASB Technical Bulletins,
(7) FASB Concepts Statements,
(8) AICPA Issues Papers and Practice
					 Bulletins, and other pronouncements of the AICPA or FASB.
"Department"
as used throughout these
						principles is the State of Maine Department of Health and Human
						Services.
"Division of Audit"
used throughout these
						Principles refers to the Department of Health and Human Services, Division of
						Audit.
"MaineCare Eligible Days"
are the actual
						days of service for which payment was made by the Office of MaineCare Services
						through the claims process.
"Necessary and Proper Costs"
are costs for
						services and items that are essential to provide appropriate resident care and
						resident activities at an efficient and economically operated facility. They
						are costs for services and items that are commonly provided and are commonly
						accepted as essential for the type of facility in question.
"Occupancy Level"
as referenced in this
						policy consists of the total licensed beds of a PNMI times the number of days
						available in the fiscal period (e.g.: A PNMI licensed for 10 beds and open for
						a full 12 month period, with the fiscal period covering the full 12 months,
						would have its occupancy level stated at 3650. Ten beds multiplied by 365 days
						in the year equals 3650 days.)
"Owners"
include any individual or
						organization with 10% or more equity interest in the provider's operation and
						any members of such individual's family or his or her spouse's family. Owners
						also include all partners and all stockholders in the provider's operation and
						all partners and stockholders or organizations that have a 10% or more equity
						interest in the provider's operation.
"Per Diem Rate"
includes total allowable
						costs divided by days of care.
"Reasonable Costs"
are those incurred by a
						provider which are reasonable and necessary in providing adequate care to
						eligible residents and which are within the requirements and limitations of
						this policy. The reasonableness and necessity of any costs will be determined
						by reference to, or in comparison with, the cost of providing comparable
						services.
"Related to the Provider"
means that the
						provider to a significant extent is associated or affiliated with, has control
						of, or is controlled by the organization furnishing the services, facilities,
						and supplies.
"Remote Island Facility"
for the purposes of
						this section, means a facility located on an island not connected to the
						mainland by a bridge.
"Resident"
as used throughout this policy
						refers to the person residing in the facility and is receiving services in the
						PNMI. The term is also synonymous with "member."
"Rider A"
is used to denote the State's
						share of funds used to draw down the federal Medicaid funds by a specific
						agency/facility. The form states the amount of State money available, the total
						federal match (Medicaid) that can be drawn down and the combined total (of
						State and Federal) that the agency/facility can receive in that fiscal
						year.
"State Licensing and Federal Certification"
as used throughout these principles are the applicable "Regulations Governing
						the Licensing and Functioning of Level I Private Non- Medical Institutions,"
						"Regulations Governing the Licensing and Functioning of Level II Private
						Non-Medical Institutions," "Regulations Governing the Licensing and Functioning
						of Level III Private Non-Medical Institutions," or "Regulations Governing the
						Licensing and Functioning of Level IV Private Non-Medical Institutions",
						"Mental Health Agency Licensing Standards and Rights of Recipients of Mental
						Health Services," "Regulations for Licensing and Certifying of Alcohol and Drug
						Treatment Services," or "Rules for the Licensure of Residential Child Care
						Facilities" and "Rights of Recipients of Mental Health Services Who are
						Children in Need of Treatment;" and the Federal Certification requirements for
						Private Non-Medical Institutions that are in effect at the time the cost is
						incurred.
"Leave (bedhold) days"
are when the resident
						is not in the facility and no treatment is provided. Leave days are not a
						covered service.
PROC. CODE
DESCRIPTION
* See Below
MAXIMUM ALLOWANCE EFFECTIVE
								  7/1/19**
MAXIMUM ALLOWANCE EFFECTIVE
								  11/1/21***
SUBSTANCE USE TREATMENT
								  FACILITIES
H0010 TD
Medically Supervised Withdrawal Services (Non
								  Hospital based)
$217.48 per diem
$385.55 per diem
H0010
Medically Supervised Withdrawal Services (Non
								  Hospital based - exception rate for low RN)
$238.12 per diem
H2034
Halfway House Services
$106.09 per diem
$165.67 per diem
H2036
Extended Care
$116.89 per diem
$137.21 per diem
H2036 HF
Residential Rehabilitation Type 1
$224.44 per diem
$287.91 per diem
H2034 HF
Residential Rehabilitation Type II
119.65 per diem
$165.67 per diem
H2036 HA
Adolescent Residential Rehabilitation
$187.67 per diem
$254.78 per diem
T1020 HF
Personal Care - Substance Use (Substance Use
								  Shelter Services)
$56.87 per diem
* Room and Board costs are not reimbursed in the rates
						for PNMI Substance Use Treatment Service
The Department is seeking and anticipates receiving
						approval from CMS for this Section. Pending approval, the increased rates are
						effective retroactive to July 1, 2016 (for * rates, above) and August 1, 2018
						(for rates **, above) for Appendix B, C, and E PNMIs.
The Department is seeking and anticipates receiving
						approval from CMS for this Section. Pending approval, the increased rates are
						effective retroactive to July 1, 2016 (for * rates, above) and August 1, 2018
						(for ** rates, above) for Appendix B, C, and E PNMIs.
The Department shall seek approval from CMS for
						this Section (for the rates *** above).
RESIDENTIAL CHILD CARE
								  FACILITY
Child Care Facility PNMI Services
Maximum Allowance Per Diem to 10/31/21
H0019-HE
Child Mental Health Level I*
$330.72 per diem
H0019-CG
Child Mental Health Level II*
$435.40 per diem
H0019-SE
Intellectual Disabilities and Autism Spectrum
								  Disorder Level I*
$396.47 per diem
H0019-U9
Intellectual Disabilities and Autism Spectrum
								  Disorder Level II*
$585.60 per diem
H0019-HA
Crisis Residential
$539.89 per diem
H0019-HU
Treatment Foster Care
$103.51 per diem
H0019-HY
Treatment Foster Care-Multidimensional (Juvenile
								  Justice)
$150.45 per diem
S9484 HA
Temporary High Intensity Service for Children in
								  ITRT Setting. This service is only available for Mental Health Level I and II
								  and Intellectual Disabilities Level I and II
By Report per hour
The Department is seeking and anticipates receiving
						CMS approval for this Section. Pending approval, the increased rates will be
						effective retroactive to July 1, 2016 (for * rates, above) and August 1, 2018
						(for ** rates, above) increased rates for Appendix B, C, and E
						PNMIs.
CHILDREN'S RESIDENTIAL CARE FACILITY -
								  Effective 11/1/21
Children's Residential Care Facility PNMI
								  Services
Maximum Allowance Per Diem Effective
								  11/1/21
H0019-HE
Mental Health Residential Treatment
								  Services
$580.09 per diem***
H0019-HI
Intellectual Disabilities/Developmental
								  Disabilities Residential Treatment Services
$727.98 per diem***
H0019-HA
Crisis Stabilization
$539.89 per diem
99510 HR
Aftercare Services - Service
$53.34 per hour***
A0425 HI
Aftercare Services - Mileage
$2.13 per mile***
H0019-HU
Therapeutic Foster Care
$103.51 per diem
H0019-HY
Therapeutic Foster Care-Multidimensional
								  (Juvenile Justice)
$150.45 per diem
S9484 HA
Temporary High Intensity Service for Children in
								  ITRT Setting. This service is only available for Mental Health Level I and II
								  and Intellectual Disabilities Level I and II
By Report per hour
The Department shall seek approval from CMS for
						this Section (for the rates *** above).
COMMUNITY RESIDENCES FOR PEOPLE WITH MENTAL
								  ILLNESS
* (H0019)
Rehabilitation Services
By Report
* (T1020-HE)
Personal Care Services-Residences For People With
								  Mental Illness
By Report
S9484 HE
Temporary High Intensity Service for Residents of
								  Appendix E
By Report per hour
Residential Care Facilities
* (T1020)
Medical and Remedial Personal Care
								  Services
By Report
* (T1020)
Medical and Remedial Services
By Report
COMMUNITY RESIDENCES FOR PEOPLE WITH
								  INTELLECTUAL DISABILITIES
RMR* (T1020)
Personal Care Services-Residences For People With
								  Intellectual Disabilities
By Report
MRP* (H0019)
PNMI Services
By Report
S9484 HI
Temporary High Intensity Service for Residents of
								  Appendix F
By Report per hour