Chapter 101, MaineCare Benefits Manual, Section 67, Nursing Facility Services

Notice of MaineCare Reimbursement Methodology Change

AGENCY: Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 67, Nursing Facility Services

NATURE OF PROPOSED CHANGES: The Department plans to submit a SPA to establish a one-time payment in state fiscal year 2025 to nursing facilities that provide comprehensive care to MaineCare veterans to meet their unique needs.

In order to receive payment, a nursing facility must meet the following criteria:

1. The facility provides critical access to veteran-focused care, including specialized training and care of war-related injuries and conditions, such as Post Traumatic Stress Disorder (PTSD) and service-connected disabilities;

2. The nursing facility is subject to Department of Veterans Affairs (VA) regulations, oversight, and reporting requirements;

3. The nursing facility board of directors is appointed by the governor; and

4. The nursing facility participates in the Maine Public Employees Retirement System.

Principle. A nursing facility that qualifies under this section will be reimbursed for services provided to residents covered under Title XIX of the United States Social Security Act based on audited cost reports.

Rate Setting. These payments will be calculated using the uniform cost reports filed by the facilities, using the following methodology:

1. The difference between the MaineCare payments and actual allowed MaineCare costs as reported on the most recent and filed cost reports for all eligible nursing facility services delivered by eligible nursing facilities as defined above.

The total of this payment across all eligible facilities shall not exceed the lesser of $8,896,077 or the difference as calculated under Step 1; and

2. Each facility’s payment shall be proportionate to its overall share of the amount calculated under Step 1 and limited to the aggregate amount across all facilities available under Step 2; and

3. For each facility, if the amount calculated under Step 1 is greater than or equal to zero, the facility is not eligible.

Audit. This payment is subject to the year-end uniform desk review audit and will be adjusted not to exceed the actual allowable costs of providing services to eligible residents.

REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2023 CH 643 An Act to Make Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and to Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2024 and June 30, 2025.