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 144-115-37 - DAYS WAITING PLACEMENT

Current through 2024-29, July 17, 2024
37.1 For current
				nursing facility residents who have no federal third party coverage or long
				term care insurance coverage and who have been determined not medically
				eligible for MaineCare nursing facility benefits, the nursing facility in which
				that member resides may receive payment at the "Days Waiting Placement" rate
				retroactive to the date the nursing facility ceased receiving other payment for
				the member, subject to the following conditions:
37.1.1 The resident has received notice that
				they are not medically eligible for MaineCare benefits, the facility has
				initiated the discharge process, and it has been determined that there is no
				safe and appropriate placement currently available.
37.1.2 The individual meets the financial
				eligibility requirements for MaineCare coverage in a cost reimbursed
				residential care facility, as determined by the regional Office for Family
				Independence.
37.1.3 The member met
				the MaineCare medical eligibility criteria in effect at the time of admission
				to the nursing facility. The nursing facility shall conduct an assessment using
				the Department's approved medical eligibility determination assessment form
				(MED) to document the member's medical eligibility. Only if the member was
				admitted prior to the MED assessment, a completed MDS may be substituted for
				the MED.
37.1.4 The nursing
				facility accepts as payment in full the rate of reimbursement for days awaiting
				placement and does not receive any additional payment from a third party to
				supplement this rate.
37.1.5 The
				nursing facility continually pursues discharge of the member. The nursing
				facility shall continue to document in the member's record all efforts to
				locate appropriate placement.
37.1.6 The member accepts the first
				available, appropriate placement within a thirty (30) mile radius of his/her
				residence (Chapter II, Section 67, Nursing Facilities, Definitions of the MBM).
				The member may accept a placement beyond the thirty (30) mile radius. However,
				this is not required. The nursing facility must notify the Department if a
				member refuses a placement meeting these criteria. If the member refuses this
				placement, the Department will issue a thirty (30) day notice to the nursing
				facility that reimbursement will terminate.
37.1.7 The Department will reimburse the
				difference between the eligible member's assessment (cost of care) and the rate
				determined by the Department. This rate shall be published on July 1st of each
				year and shall be equal to the sum of the Statewide average cost reimbursed
				residential room and board rate less fixed costs and the administrative
				allowance, and the average MaineCare rates. It is the responsibility of the
				nursing facility to assist the member in applying for any benefits that the
				resident may be eligible for, such as federal Supplemental Security Income,
				that might be applied toward the member's cost of care. Payments will not be
				considered in the reconciliation of the nursing facility's cost report. This
				includes removal of the days of care from the nursing home census in such
				reconciliation.