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-2 - Adult Family Care Services

Current through 2024-29, July 17, 2024
Providers will be reimbursed the resource-adjusted price
					 for each member according to the resource group the member is assigned as a
					 result of the MDS-ALS assessment. The Department will reimburse updated
					 resource adjusted prices twice each year upon reassessments as detailed in
					 Chapter II, Section II. Effective July 1, 2019, payment rates attributable to
					 wages and salaries for personal care and related services will be increased
					 annually by an inflation adjustment cost-of-living percentage in accordance
					 with the United States Department of Labor, Bureau of Labor Statistics Consumer
					 Price Index, Medical Care Services index from the prior December for
					 professional services, nursing home and adult day care services. Those cost of
					 living increases shall continue annually until the Department has completed a
					 rate study for adult family care services and the rates in the rate study have
					 been implemented. Providers must bill using the UB-92 and according to
					 "
Billing Instructions for Adult Family Care Services
."
Description
Maximum Allowance
Adult Family Care Services
Resource-Adjusted Price, determined by Resource
								group assignment as a result of MDS-ALS Assessment
The Department is seeking and anticipates receiving Centers
					 for Medicare and Medicaid Services(CMS) approval for this Section. Pending
					 approval, increased rates will be as follows:
Resource Group
MaineCare Weight
Resource Adjusted Price** (Based on $46.79
								Unadjusted Price Multiplied by MaineCare weight)
Effective 7/1/16 to 6/30/17
Resource Adjusted Price** (Based on $48.43
								Unadjusted Price Multiplied by MaineCare weight)
Effective Retroactive to 7/1/17
Resource Adjusted * Price*** (Based on $53.71
								Unadjusted Price Multiplied by MaineCare weight)
Effective Retroactive to 8/1/18
Resource Adjusted * Price*** (Based on $55.29
								Unadjusted Price Multiplied by MaineCare weight)
Effective 7/1/19
1
1.657
$77.53
$80.24
$89.00
$91.62
2
1.210
$56.62
$58.60
$64.99
$66.90
3
1.360
$63.63
$65.86
$73.05
$75.19
4
1.027
$48.05
$49.73
$55.16
$56.78
5
.924
$43.23
$44.75
$49.63
$51.09
6
.804
$37.62
$38.94
$43.18
$44.45
7
.551
$25.78
$26.68
$29.60
$30.47
8
.551
$25.78
$26.68
$29.60
$30.47
Remote Island Facility Supplemental Payment
:
					 If CMS approves, effective October 1, 2015, Remote Island Facilities are
					 entitled to a supplemental payment of fifteen (15) percent in addition to the
					 standard MaineCare reimbursement rate, as set forth in Chapter III. Eligible
					 facilities are allowed to retain this supplemental payment in addition to the
					 total allowable rate under these rules.
Resource Group
MaineCare Weight
Resource Adjusted Price** (Based on $51.74
								Unadjusted Price Multiplied by MaineCare Weight)
Effective 10/1/15-6/30/16
Resource Adjusted Price** (Based on $53.81
								Unadjusted Price Multiplied by MaineCare Weight)
Effective 7/1/16 to
								6/30/17
Resource Adjusted Price** (Based on $55.69
								Unadjusted Price Multiplied by MaineCare Weight)
Effective Retroactive to 7/1/17
Resource* Adjusted Price*** (Based on $61.76
								Unadjusted Price Multiplied by MaineCare Weight)
Effective Retroactive to 8/1/18
1
1.657
$85.73
$89.16
$92.28
$102.34
2
1.210
$62.60
$65.11
$67.39
$74.73
3
1.360
$70.36
$73.18
$75.74
$83.99
4
1.027
$53.14
$55.26
$57.19
$63.43
5
0.924
$47.81
$49.72
$51.46
$57.07
6
0.804
$41.60
$43.26
$44.78
$49.66
7
0.551
$28.51
$29.65
$30.69
$34.03
8
0.551
$28.51
$29.65
$30.69
$34.03
Resource Group
MaineCare Weight
Resource* Adjusted Price*** (Based on $63.59
								Unadjusted Price Multiplied by MaineCare Weight)
Effective
								7/1/19
1
1.657
$105.37
2
1.210
$76.94
3
1.360
$86.48
4
1.027
$65.31
5
0.924
$58.76
6
0.804
$51.13
7
0.551
$35.04
8
0.551
$35.04
*The increase in rates for services effective August 1,
					 2018 and July 1, 2019 must be attributed directly to the wages and salaries of
					 the professional staff delivering the personal care and related services to
					 members.
** The Department is seeking and anticipates receiving
					 approval from CMS for these rates. Pending approval of the request, the rates
					 will be effective as noted.
*** The Department is seeking and anticipates receiving
					 approval from CMS for these rates. Pending approval of the request, the rates
					 will be effective as noted.