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-50 - Principles of Reimbursement for Intermediate Care Facilities for the Mentally Retarded › Subsection 144-101-III-50-1100 - ALLOWABLE COSTS

Current through 2024-29, July 17, 2024
1110
Principle
Federal law requires that payment for long term care
						facility services provided under MaineCare shall be provided through the use of
						rates that are reasonable and adequate to meet the costs incurred by
						efficiently and economically operated facilities in order to provide care
						services in conformity with applicable State and Federal laws, regulations, and
						quality and safety standards. Costs incurred by efficiently and economically
						operated facilities include costs that are reasonable, necessary, and related
						to patient care, subject to principles relating to specific items of revenue
						and cost.
1111 Costs must
					 be ordinary, reasonable, and necessary and related to resident care. They must
					 be of the nature and magnitude that prudent and cost conscious management would
					 pay for a specific item or service. A cost is considered reasonable if in its
					 nature and amount, it does not exceed that which would be incurred by a prudent
					 person under the circumstances prevailing at the time the decision was made to
					 incur the cost.
1112 Costs must not
					 be of the type conceived for the purpose of circumventing the regulations. Such
					 costs will be disallowed under the principle that the substance of any
					 transaction will prevail over form.
1113 Costs that relate to inefficiency,
					 unnecessary or luxurious care, or unnecessary or luxurious facilities, and to
					 activities not common and accepted in the field of mental retardation services
					 are not allowable.
1114
					 Compensation to be allowable must be reasonable and for services that are
					 necessary and related to resident care habilitation and active treatment and
					 pertinent to the operation of the facility. The services must actually be
					 performed and must be paid in full. The compensation must be reported to all
					 appropriate State and Federal tax authorities to the extent required by law for
					 income tax, social security, and unemployment insurance purposes.
1115 Costs incurred to comply with changes in
					 Federal or State laws and regulations for increased care, habilitation
					 treatment, and improved facilities are to be considered reasonable and
					 necessary costs.
1116 Costs
					 incurred for resident services that are rendered in common to MaineCare
					 residents, as well as to non-MaineCare residents, will be allowed on a prorated
					 basis unless there is a specific allocation defined elsewhere in these
					 Principles.
1120
Definitions
1121
					 Reasonable Costs are those costs incurred by a provider that are ordinary and
					 necessary in providing care, rehabilitation, and treatment to publicly aided
					 residents and are within the requirements and limitations of these Principles.
					 The reasonableness and necessity of any costs shall be determined by reference
					 to or in comparison with the costs of providing comparable services described
					 in the MaineCare Benefits Manual or absolute costs related to resident's unique
					 circumstances and needs.
1122
					 Allowable Costs are the operating costs after the adjustment required by the
					 Principles have been applied to the provider's total operating costs as
					 reported in the annual costs reports.
1123 Necessary and Proper Costs are those
					 costs which are appropriate and helpful in developing and maintaining the
					 efficient and economical operation of resident care and habilitation facilities
					 and activities. They are usually costs that are common and accepted occurrences
					 in the field of mental retardation.