Date posted:
Attachment(s):
Notice of Agency Emergency Rule-making Adoption
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
The Department adopts this emergency rule, which amends Chapter 101, MaineCare Benefits Manual, Chapter III, Section 67, effective February 1, 2025.
The Department’s principal purpose of this emergency rulemaking is to establish new reimbursement methodology for Nursing Facilities. These changes include moving toward creating a prospective payment system that incorporates acuity measures that capture the range of need associated with caring for all residents, decreases administrative burden, and ensures rates keep pace with changes in the cost of delivering services. Regional variations for labor costs, as required by 22 M.R.S. Sec. 1708(3)(E), have been revised so that the four regions all have a factor of 1.0 for the four regions, to reflect the fact that analysis does not show any regional variation in labor costs. Occupancy adjustments have also been removed, at the request of providers in the Rate Reform process and to the benefit of providers
In compliance with 22 M.R.S. Sec. 3173-J(2), the Department conducted a rate determination process: a Rate Determination Initiation Notice was issued on January 12, 2023. MaineCare presented the draft reimbursement methodology and definitions to providers and interested stakeholders on March 13, 2023; April 12, 2023; May 17, 2023, June 5, 2023; June 26, 2023; March 7, 2024; March 8, 2024, and October 23, 2024. The Department accepted public comments through October 30, 2024, and responded in writing to comments with an explanation of whether and how feedback was incorporated into the final reimbursement methodology and rates.
The Department shall submit to the Centers for Medicare & Medicaid Services, and anticipates approval, for State Plan Amendments related to these provisions.
Pursuant to 5 M.R.S §8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: February 1, 2025
AGENCY CONTACT PERSON: Derrick Grant, Special Projects
AGENCY NAME: Division of Policy
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
EMAIL: derrick.grant@maine.gov
TELEPHONE: (207)-624-6931 FAX: (207) 287-6106
TTY users call Maine relay 711
Emergency
Office: MaineCare Services
Emergency
Email: derrick.grant@maine.gov
Comment deadline:
Effective date:
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