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 › Appendix 144-101-III-97-C - MEDICAL AND REMEDIAL SERVICE FACILITIES › Section 144-101-III-97-C-3000 - GENERAL DESCRIPTION OF THE PRICING METHODOLOGY

Current through 2024-29, July 17, 2024
3010
Direct Care Services Included in
						the Case Mix-Adjusted Price
The Department utilizes a case mix-adjusted pricing
						  methodology with three peer groups for medical and remedial services provided
						  in residential care facilities, unless the provider is exempted from
						  participation in this Appendix. The Department calculates the price by:
* Grouping residential care facilities that had
						  completed MDS-RCA assessments for MaineCare residents on 9/15/98, and that had
						  audited costs for 1998 (hereinafter the base year), into four peer groups, as
						  described in Section
						  6000;
Aggregating total allowable direct care costs,
						  applicable workers compensation costs, medical supplies (see Section 3020 ) and
						  Department-approved medical and remedial services training costs in the base
						  year to calculate each provider's adjusted direct care costs;
* Dividing the adjusted direct care costs by the actual
						  occupancy to determine an adjusted direct care cost/day;
* Inflating the direct care cost from the base year
						  through June 30, 2001 using the regional variations in labor costs by comparing
						  the percentage increase in the weighted average of the actual salaries paid to
						  direct care staff in the base year by medical and remedial PNMIs covered under
						  this Appendix to the weighted average of the actual salaries paid to direct
						  care staff in the subsequent year (based on that subsequent year's audited or
						  as filed cost report);
* Dividing each facility's inflated adjusted direct
						  care cost/day by the facility-specific MaineCare case mix index as of September
						  15, 1998, and aggregating to arrive at an average industry Direct Care Price
						  (hereinafter DCP) for each of the four peer groups. MDS assessments that could
						  not be classified on the September 15, 1998 roster were excluded from the
						  calculation;
* Adding a Program Allowance (PA) determined by the
						  Commissioner, as set forth in Chapter III, Section 97; and
* Calculating the MaineCare payment to each provider by
						  multiplying the DCP by the facility-specific case mix index for MaineCare
						  members, and adding the applicable program allowance.
3020
Personal Care Services Component
						Not Included in the Case Mix-Adjusted Price
Effective July 1, 2002, the Department will determine
						  the rate for the personal care services component by the following
						  method:
* Aggregating total audited allowable costs for
						  housekeeping, laundry, and dietary wages, taxes, and benefits, including
						  applicable Worker's Compensation costs, and benefits in the facility's base
						  year;
* Dividing the costs by the actual occupancy to
						  determine the personal care services component rate; and
* Inflating the personal care services component rate
						  through June 30, 2003.
The actual allowable personal care services costs will
						  be determined at the time of audit of the cost report required under Chapter
						  III, Section 3300, and cost settled up to each PNMI's facility-specific
						  personal services cap.
For new facilities, the allowable personal care
						  services costs will be determined initially based on a pro forma cost
						  report.
3030
Medical
						Supplies Included in the Price
Medical supplies contained in the direct care price
						  include but are not limited to the following items: non-prescription
						  analgesics, non-prescription antacids, applicators, bandages, blood pressure
						  equipment, non-prescription calcium supplements, cotton, cough syrup and
						  expectorants, dietary supplements, disinfectants, dressings, enema equipment,
						  gauze bandages, sterile or non-sterile gloves, ice bags, non-prescription
						  laxatives, lotions, ointments and creams, stethoscopes, non-prescription
						  supplies, tapes, thermometers, and rectal medicated wipes.