Attention Section 45 Hospitals, Distinct Psychiatric and Substance Use Disorder (SUD) Units: Rate Determination Update

Jun 16, 2023

Last Fall, MaineCare initiated a rate determination for Section 45, Distinct Psychiatric and SUD units. Our goal for this determination was to update the reimbursement for distinct psychiatric and SUD units from the discharge rates listed in Chapter III, Section 45 and to eliminate inequitable provider-specific rates for distinct psychiatric units.     

We developed a draft reimbursement methodology that generally aligns with Medicare’s payment method. MaineCare presented this draft rate methodology and definitions to providers and interested stakeholders in January 2023 and accepted comments until February 3, 2023.     

The Department will be updating its claims processing system, retroactive to July 1, 2023, to align with the definitions and methodology we have developed. We expect this change to be in place by early October 2023. We will send another message when we have made those updates.     

To prepare for the new rate methodology, and to allow the Department and providers to adjust claims more easily after implementation, those facilities identified by the Department as meeting the definitions for Distinct Psychiatric or Distinct SUD Units, will soon be receiving a direct email with billing guidance from the Department. According to that guidance, hospitals may begin billing for distinct unit stays after June 30, 2023.      

Proposed definitions:    

Distinct Psychiatric Unit is a unit within an acute care non-critical access hospital that specializes in the delivery of inpatient psychiatric services. The unit must be reimbursed as a distinct psychiatric unit as a sub provider on the Medicare cost report, or must be comprised of beds reserved for use for involuntary commitments under the terms of a contract with the Department or it’s designated entity. The claim must also be distinguishable as representing a discharge from a distinct psychiatric unit in the MaineCare claims processing system.     

Distinct Substance Use Disorder Unit is a unit that combines the medical management of withdrawal with a structured inpatient rehabilitation program. Services include coordinated group education and psychotherapy, and individual psychotherapy and family counseling as needed. Licensed Alcohol and Drug Abuse Counselors (LADCs) assist medical staff in developing an interdisciplinary plan of care. Evidence-based best practices such as motivational interviewing are used by staff who are trained in substance use disorder treatment. The claim must also be distinguishable as representing a discharge from a distinct substance use disorder unit in the MaineCare claims processing system. This label is not a Medicare designation.     

These proposed changes will now move through the Maine Administrative Procedures Act (MAPA) process. Providers will have the opportunity to provide feedback and/or comment on these changes at that time.   

  

Please contact Jessica Levesque, Rate Reform Project Manager for questions on this rate determination.