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 › Appendix 144-101-III-21-IIA - Weekly Hours Authorized per Facilit

Current through 2024-29, July 17, 2024
APPENDIX IIA
Weekly Hours Authorized per
									 Facility
Home Support Agency per
									 diem
Provider
Location Address
MaineCare Provider ID
Instructions
MaineCare Member
Regular Support Hours up to
									 168
Hours in excess of 168
Medical Support Hours
Total Support Hours (sum total of all
									 types of support hours)
A
Enter the weekly authorized support hours under
									 each type by MaineCare member for this facility
B
C
D
Sum of total weekly authorized support hours
									 for all members in facility by type of support and total facility.
E
F
TOTAL weekly authorized support hours by
									 each type
Regular Support Hours up to 168
Hours In Excess of 168
Medical Support Hours
Hourly Support reimbursement rates by
									 type
$32.13*
$ $28.75*
$ 38.69*
Amount includes service provider tax
									 expense.
Total Weekly Authorized amount for
									 facility by type
Total weekly authorized support hours
									 multiplied by hourly support rate for each type
Number of days per week
7
7
7
7
7
7
Seven (7) days in a week
Number of members in
									 facility
(1 to 6)
Total number of members in facility that are
									 authorized for service. For Medical Add on, it would only be the number of
									 member in facility that are authorized for those types of services.
*The Department is seeking and anticipates receiving
						  approval from the federal Centers for Medicare and Medicaid Services for these
						  changes.
Total Authorized Per Diem (Daily) rate
									 amount
Total Weekly Authorized amount divided by
									 number of days per week and then by the number for members in the facility for
									 each type.
Total amount / Days / # of Consumers
*Maximum allowance effective 7/1/18.
Providers are responsible for calculating all
									 amounts payable to them in accordance with the above-listed rates and rate
									 calculation formula. As an assistive tool, OMS provides sample calculations for
									 each rate based on the number of weekly service hours provided and the number
									 of members served. Calculation Tables 1& 2 are accessible through the DHHS
									 website
http://www.maine.gov/dhhs/oads/MaineCare/index.shtml
.
									 Providers may request paper copies of calculation Appendices IIA & IIB by
									 calling OMS at
1-866-690-5585. TTY 711
THE DEPARTMENT EXPRESSLY DISCLAIMS THE ACCURACY
									 OF THE CALCULATIONS TABULATED IN Appendix IIA & IIB AND EXPRESSLY DISCLAIMS
									 ANY AND ALL LIABILITY FOR LOSSES, INCURRED COSTS, OR OTHER DETRIMENT SUFFERED
									 BY ANY PROVIDER AS A RESULT OF RELIANCE UPON INFORMATION CONTAINED IN Appendix
									 IIA & IIB.
Appendix IIA is for members Authorized with
									 Regular service, Appendix IIB is for members authorized with Medical Add On
									 service.
MaineCare Member
Regular Support Rate up to
									 168
Hours in excess of 168
Medical Support Rate
A
The total authorized per diem (daily) rate by
									 member
B
C
D
E
F