Subsection 144-101-III-97-1400 - REQUIREMENTS FOR MAINECARE REIMBURSEMENT1400.1 In order to be reimbursed, all PNMIs identified as children's residential care, substance use treatment, community residences for persons with mental illness, and Appendix F scattered site PNMIs for people for intellectual disabilities must be licensed as applicable, in accordance with the Mental Health Agency Licensing Standards and Rights of Recipients of Mental Health Services, Regulations for Licensing and Certification of Alcohol and Drug treatment Services, or Rules for the Licensure of Residential Child Care Facilities/Rights of Recipients of Mental Health Services Who are Children in Need of Treatment. In order to be reimbursed, medical and remedial service PNMIs and non-case mixed must be licensed by the Division of Licensing and Certification in the Department of Health and Human Services (See 10-149 C.M.R. , Ch. 113). Appendix F, scattered site PNMIs for persons with intellectual disabilities, may be licensed as either a residential care facility or as a mental health provider in accordance with the Mental Health Agency Licensing Standards and Rights of Recipients of Mental Health Services, Regulations for Licensing and Certification of Alcohol and Drug treatment services.1400.2 All PNMIs must obtain licensure and a signed Provider/Supplier Enrollment Agreement with the Department of Health and Human Services, Office of MaineCare Services (OMS). Providers must submit a copy of the license accompanying the Provider/Supplier Enrollment Agreement to the Department.1400.3 Types of PNMIs considered for MaineCare reimbursement, subject to the availability of funds, include:1400.3.1 Facilities providing Private Non-Medical Institution services to members with significant mental or physical disability requiring structured, individualized habilitative or rehabilitative in-home programming as outlined in the provider agreement with the PNMI.1400.3.2 Facilities with licensed Private Non-Medical Institution beds at scattered locations serving a minimum of four eligible members, as long as the service provided consistently fits within the definition of the applicable appendix stated below. Appendix B Substance Use Treatment Facilities
Appendix D Children's Residential Care Facilities
Appendix F Non-Case Mixed Medical and Remedial PNMIs
1400.4 Except for Children's Residential Care Facilities covered under Appendix D, the Department will reimburse PNMIs for services provided to eligible members based on an interim rate that the Department establishes and determines as reasonable and adequate to meet the costs that are incurred by an efficiently and economically operated facility in order to provide care and services in conformity with applicable State and Federal laws, regulations, and quality and safety standards. Appendix D standard rates are not interim and are not subject to cost settlement guidelines detailed in this Chapter.1400.5 The Department requires cost reimbursed facilities to submit annual cost reports as stated in Section 3300. C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-97, subsec. 144-101-III-97-1400