C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-45, subsec. 144-101-III-45.11
State owned psychiatric hospitals will be reimbursed as follows:
The MaineCare total annual obligation to the hospitals will be the sum of: MaineCare's obligation of the following: inpatient services + outpatient services + days awaiting placement + hospital-based physician + direct graduate medical education costs + estimated DSH obligation - third party liability payments. Amounts are calculated as described below:
The total MaineCare inpatient operating costs from the most recent Interim Cost Settlement Report inflated forward as described in Section 45.02-1 to the current State fiscal year.
MaineCare outpatient costs inflated to the current State fiscal year using the most recent Interim Cost Settlement Report.
The Department will reimburse prospectively at the estimated statewide average rate per member day for NF services. The Department shall adopt the prospective statewide average rates per member day for NF services that are specified in the "Principles of Reimbursement for Nursing Facilities", MaineCare Benefits Manual Chapter III, Section 67. The Department will compute the average statewide rate per member day based on the simple average of the NF rate per member day for the applicable State fiscal year(s) and prorated for a hospital's fiscal year.
MaineCare's share of hospital-based physician + graduate medical education costs are taken from the most recent hospital Interim Cost Settlement Report inflated to the current year.
The Department will reimburse claims submitted for inpatient and outpatient services, subject to final cost settlement.
The Department will calculate MaineCare's Final Cost Settlement with a hospital using the Medicare Final Cost Report and MaineCare paid claims history for the year for which settlement is being performed. A final DSH adjustment will be made for eligible hospitals.
C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-45, subsec. 144-101-III-45.11