10-144-101 Me. Code R. § III-97-D-6000

Current through 2024-44, October 30, 2024

Section 144-101-III-97-D-6000 - RATE-SETTING

6000.1 The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for this Section. Pending approval, increased reimbursement rates will be effective retroactive to July 1, 2016:

The following capitated rates apply to Appendix D services:

Intellectual Disabilities and Autism Spectrum Disorder - Level I- $396.47 per diem

Intellectual Disabilities and Autism Spectrum Disorder - Level II- $585.60 per diem

Child Mental Health- Level I - $330.72 per diem

Child Mental Health - Level II - $435.40 per diem

Crisis Stabilization Residential Services - $539.89 per diem

Therapeutic Foster Care - $103.51 per diem

Therapeutic Foster Care- Multidimensional - $150.45 per diem

Temporary High Intensity Service - By Report per hour

6000.2 The Department shall seek approval from the federal Centers for Medicare and Medicaid Services for this Section.

The following capitated rates apply to Appendix D services effective November 1, 2021:

Intellectual Disabilities/Developmental Disabilities Residential Treatment Facility - $727.98 per diem

Mental Health Residential Treatment Facility - $580.09 per diem

Aftercare Services - Service - $53.34 per hour

Aftercare Services - Mileage - $2.13 per mile

Providers bill the Department on a per diem basis for each child. The capitated rate includes all PNMI services required by child for his/her category of level of care including all staffing required pursuant to State of Maine licensing guidelines, and as identified in the child's individual service plan. See Chapter II requirements for Temporary High Intensity Services. There is no cost settlement for Appendix D PNMI services.

Aftercare Services are reimbursed per hour. Aftercare Services mileage may be reimbursed per mile for staff traveling from the facility to the location of the Aftercare service and back, as applicable.

6000.3 The provider must also submit, upon request, such data, statistics, schedules, or other information that the Department requires.

10-144 C.M.R. ch. 101, § III-97-D-6000