C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-97, subsec. 144-101-III-97-9000
"Accrual Basis of Accounting" means that revenue is reported in the period when it is earned, regardless of when it is collected, and expenses are reported in the period in which they are incurred, regardless of when they are paid.
"Allowable Costs" are those operating costs remaining after the adjustments required by the Principles have been applied to the provider's total operating costs reported in the annual cost reports.
"Cash Basis of Accounting" means revenues are recognized only when cash is received and expenditures for expense and asset items are not recorded until cash is disbursed for them.
"Census/Days of Care": For purposes of counting the number of patient days, the day of the patient's admission will be counted, but the day of discharge will not be counted.
"Centers for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing Administration (HCFA)" is the Agency within the U.S. Department of Health and Human Services (HHS) responsible for developing and implementing policies governing the Medicare and federal Medicaid programs.
"Common Ownership" exists if an individual or individuals possess 10% or more ownership or equity in the provider and the institution or organization serving the provider.
"Control" exists if an individual or an organization has the power, directly or indirectly, to significantly influence or direct the actions or policies of an organization or institution.
"Cost Finding" are the processes of segregating costs by cost centers and allocating indirect cost to determine the cost of services provided.
"Days of Care" are total days of care provided whether or not payment is received and the number of any other days for which payment is received. (Note: Discharge days are included only if payment is received for these days.)
"Generally Accepted Accounting Principles (GAAP)" are those accounting principles with substantial authoritative support. In order of authority the following documents are considered GAAP:
"Department" as used throughout these principles is the State of Maine Department of Health and Human Services.
"Division of Audit" used throughout these Principles refers to the Department of Health and Human Services, Division of Audit.
"MaineCare Eligible Days" are the actual days of service for which payment was made by the Office of MaineCare Services through the claims process.
"Necessary and Proper Costs" are costs for services and items that are essential to provide appropriate resident care and resident activities at an efficient and economically operated facility. They are costs for services and items that are commonly provided and are commonly accepted as essential for the type of facility in question.
"Occupancy Level" as referenced in this policy consists of the total licensed beds of a PNMI times the number of days available in the fiscal period (e.g.: A PNMI licensed for 10 beds and open for a full 12 month period, with the fiscal period covering the full 12 months, would have its occupancy level stated at 3650. Ten beds multiplied by 365 days in the year equals 3650 days.)
"Owners" include any individual or organization with 10% or more equity interest in the provider's operation and any members of such individual's family or his or her spouse's family. Owners also include all partners and all stockholders in the provider's operation and all partners and stockholders or organizations that have a 10% or more equity interest in the provider's operation.
"Per Diem Rate" includes total allowable costs divided by days of care.
"Reasonable Costs" are those incurred by a provider which are reasonable and necessary in providing adequate care to eligible residents and which are within the requirements and limitations of this policy. The reasonableness and necessity of any costs will be determined by reference to, or in comparison with, the cost of providing comparable services.
"Related to the Provider" means that the provider to a significant extent is associated or affiliated with, has control of, or is controlled by the organization furnishing the services, facilities, and supplies.
"Remote Island Facility" for the purposes of this section, means a facility located on an island not connected to the mainland by a bridge.
"Resident" as used throughout this policy refers to the person residing in the facility and is receiving services in the PNMI. The term is also synonymous with "member."
"Rider A" is used to denote the State's share of funds used to draw down the federal Medicaid funds by a specific agency/facility. The form states the amount of State money available, the total federal match (Medicaid) that can be drawn down and the combined total (of State and Federal) that the agency/facility can receive in that fiscal year.
"State Licensing and Federal Certification" as used throughout these principles are the applicable "Regulations Governing the Licensing and Functioning of Level I Private Non- Medical Institutions," "Regulations Governing the Licensing and Functioning of Level II Private Non-Medical Institutions," "Regulations Governing the Licensing and Functioning of Level III Private Non-Medical Institutions," or "Regulations Governing the Licensing and Functioning of Level IV Private Non-Medical Institutions", "Mental Health Agency Licensing Standards and Rights of Recipients of Mental Health Services," "Regulations for Licensing and Certifying of Alcohol and Drug Treatment Services," or "Rules for the Licensure of Residential Child Care Facilities" and "Rights of Recipients of Mental Health Services Who are Children in Need of Treatment;" and the Federal Certification requirements for Private Non-Medical Institutions that are in effect at the time the cost is incurred.
"Leave (bedhold) days" are when the resident is not in the facility and no treatment is provided. Leave days are not a covered service.
PROC. CODE | DESCRIPTION * See Below | MAXIMUM ALLOWANCE EFFECTIVE 7/1/19** | MAXIMUM ALLOWANCE EFFECTIVE 11/1/21*** | ||
SUBSTANCE USE TREATMENT FACILITIES | |||||
H0010 TD | Medically Supervised Withdrawal Services (Non Hospital based) | $217.48 per diem | $385.55 per diem | ||
H0010 | Medically Supervised Withdrawal Services (Non Hospital based - exception rate for low RN) | $238.12 per diem | |||
H2034 | Halfway House Services | $106.09 per diem | $165.67 per diem | ||
H2036 | Extended Care | $116.89 per diem | $137.21 per diem | ||
H2036 HF | Residential Rehabilitation Type 1 | $224.44 per diem | $287.91 per diem | ||
H2034 HF | Residential Rehabilitation Type II | 119.65 per diem | $165.67 per diem | ||
H2036 HA | Adolescent Residential Rehabilitation | $187.67 per diem | $254.78 per diem | ||
T1020 HF | Personal Care - Substance Use (Substance Use Shelter Services) | $56.87 per diem | |||
* Room and Board costs are not reimbursed in the rates for PNMI Substance Use Treatment Service
The Department is seeking and anticipates receiving approval from CMS for this Section. Pending approval, the increased rates are effective retroactive to July 1, 2016 (for * rates, above) and August 1, 2018 (for rates **, above) for Appendix B, C, and E PNMIs.
The Department is seeking and anticipates receiving approval from CMS for this Section. Pending approval, the increased rates are effective retroactive to July 1, 2016 (for * rates, above) and August 1, 2018 (for ** rates, above) for Appendix B, C, and E PNMIs.
The Department shall seek approval from CMS for this Section (for the rates *** above).
RESIDENTIAL CHILD CARE FACILITY | ||
Child Care Facility PNMI Services | Maximum Allowance Per Diem to 10/31/21 | |
H0019-HE | Child Mental Health Level I* | $330.72 per diem |
H0019-CG | Child Mental Health Level II* | $435.40 per diem |
H0019-SE | Intellectual Disabilities and Autism Spectrum Disorder Level I* | $396.47 per diem |
H0019-U9 | Intellectual Disabilities and Autism Spectrum Disorder Level II* | $585.60 per diem |
H0019-HA | Crisis Residential | $539.89 per diem |
H0019-HU | Treatment Foster Care | $103.51 per diem |
H0019-HY | Treatment Foster Care-Multidimensional (Juvenile Justice) | $150.45 per diem |
S9484 HA | Temporary High Intensity Service for Children in ITRT Setting. This service is only available for Mental Health Level I and II and Intellectual Disabilities Level I and II | By Report per hour |
The Department is seeking and anticipates receiving CMS approval for this Section. Pending approval, the increased rates will be effective retroactive to July 1, 2016 (for * rates, above) and August 1, 2018 (for ** rates, above) increased rates for Appendix B, C, and E PNMIs.
CHILDREN'S RESIDENTIAL CARE FACILITY - Effective 11/1/21 | ||
Children's Residential Care Facility PNMI Services | Maximum Allowance Per Diem Effective 11/1/21 | |
H0019-HE | Mental Health Residential Treatment Services | $580.09 per diem*** |
H0019-HI | Intellectual Disabilities/Developmental Disabilities Residential Treatment Services | $727.98 per diem*** |
H0019-HA | Crisis Stabilization | $539.89 per diem |
99510 HR | Aftercare Services - Service | $53.34 per hour*** |
A0425 HI | Aftercare Services - Mileage | $2.13 per mile*** |
H0019-HU | Therapeutic Foster Care | $103.51 per diem |
H0019-HY | Therapeutic Foster Care-Multidimensional (Juvenile Justice) | $150.45 per diem |
S9484 HA | Temporary High Intensity Service for Children in ITRT Setting. This service is only available for Mental Health Level I and II and Intellectual Disabilities Level I and II | By Report per hour |
The Department shall seek approval from CMS for this Section (for the rates *** above).
COMMUNITY RESIDENCES FOR PEOPLE WITH MENTAL ILLNESS | ||
* (H0019) | Rehabilitation Services | By Report |
* (T1020-HE) | Personal Care Services-Residences For People With Mental Illness | By Report |
S9484 HE | Temporary High Intensity Service for Residents of Appendix E | By Report per hour |
Residential Care Facilities | ||
* (T1020) | Medical and Remedial Personal Care Services | By Report |
* (T1020) | Medical and Remedial Services | By Report |
COMMUNITY RESIDENCES FOR PEOPLE WITH INTELLECTUAL DISABILITIES | ||
RMR* (T1020) | Personal Care Services-Residences For People With Intellectual Disabilities | By Report |
MRP* (H0019) | PNMI Services | By Report |
S9484 HI | Temporary High Intensity Service for Residents of Appendix F | By Report per hour |
C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-97, subsec. 144-101-III-97-9000