Subsection 144-101-III-97-3000 - REIMBURSEMENT METHOD3000.1 The Department will reimburse facilities for services provided to members based on a rate that the Department establishes on a prospective basis and determines is reasonable and adequate to meet the costs incurred by an efficiently and economically operated facility. The provider must provide care and services in conformity with applicable State and Federal laws, regulations, and quality and safety standards.3000.1.1 Except for Appendices B and D facilities, the Department will limit reimbursement to the approved amount in Section 2400. Appendices B and D facilities receive a standard rate not subject to Section 2400 adjustments for allowability of cost.3000.2 Rate Setting Procedures See applicable Appendix for type of Private Non-Medical Institution: Appendix B Substance Use Treatment Facilities
Appendix C Medical and Remedial Service Facilities Participating in Case Mix
Appendix D Children's Residential Care Facilities
Appendix E Community Residences for Persons with Mental Illness
Appendix F Non-Case Mixed Medical and Remedial Facilities
3000.3 Rate Adjustments For Facilities Under Appendices E and F Facilities covered under Appendices E and F may request rate adjustments as necessary. The relevant Appendix details the process for such requests. The Department will not grant retroactive rate adjustments unless they are approved by the OMS and the Department under exceptional circumstances as determined by these two agencies.
3000.4 For out-of-state PNMI services provided by out-of-state providers, the Division of Financial Services will determine whether the rate paid to these providers will be either 1) based on the methodology set forth in this section, or 2) be the Medicaid rate of the state in which the PNMI services are provided. The following is subject to CMS approval
3000.5 An Appendix C PNMI that qualifies as a "remote island facility" under this section will receive a fifteen (15) percent supplemental payment in addition to their MaineCare rate. This increase will apply only to facilities located on an island not connected to the mainland by a bridge. C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-97, subsec. 144-101-III-97-3000