MaineCare Notice of Agency Rule-making Adoption, MaineCare Benefits Manual Chapter III, Section 67

Nov 21, 2023

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes.  The MaineCare Benefits Manual is available on-line at the Secretary of State’s website. 

Below, please find a MaineCare Notice of Agency Rule-making Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.

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Notice of Agency 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:  This letter gives notice of adopted rule: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities.

The Department adopts the following changes to 10-144 C.M.R., Chapter 101, Ch. III, Section 67, Principles of Reimbursement for Nursing Facilities:

• Removes language that stated the Department is seeking approval from CMS for changes where approval has been granted, and adds CMS approval language where the Department is seeking CMS approval.

• Changes the date of the most recently filed cost report for purposes of subsequent rebasing from the report available by April 1st of the re-basing year to the report available by June 1st of the re-basing year, to ensure the Department uses the most recent cost reports available.

• Principle 13.2 (Cost Reports):  The Department made two changes: (1) To comply with the Social Security Act, 42 U.S.C. Section 1320a-7k(d), if a nursing facility determines from the cost report that the nursing facility owes moneys to the Department, it must submit 100% (changed from 50%) of the amount owed to the Department with its filed cost report; and (2) In compliance with P.L. 2023, ch. 121, added a requirement that if it is determined that the Department owes the facility money, the Department must reimburse at least seventy-five percent (75%) of the settlement pursuant to the facility’s cost reports within ninety (90) days of receipt.

• Adds a list of twenty items that nursing facilities must submit as supporting documentation with the cost report to support a more accurate analysis of costs.

• Principle 13.4: The Department adopts changes that formalize the process for the Division of Audit to accept cost reports for completeness and adequacy of all supporting documentation. The acceptance review should be completed within 45 days of receipt of the cost report. The Division of Audit will continue to perform what were previously known as uniform desk reviews on each cost report that has been accepted. The term “audit” has been substituted for the previous term “uniform desk review.” The Department deleted the rule requirement that such audits be completed within three hundred and sixty five (365) days after receipt of an acceptable cost report filing. The Department made changes to the final rule from the proposed rule, after receiving comments and also Office of Attorney General review, to clarify the provision.

• Adds health savings accounts and flexible spending accounts to the list of Direct Care Cost Components.

• Adds background checks and software costs and licensing fees to the list of allowable costs for the routine component of the rate.

• Principle 17.4.2.6 (Purchased Central Office services): Adds “Purchased Central Office Services” to the list of Administration Functions under Routine Cost Components to clarify that Central Office services purchased from another provider are only allowable to the extent they are actual costs, as a service provided by a related party. After comments, the Department added clarifying language to the final rule, clarifying that the nursing facility providing this service to another nursing facility, would not be reimbursed for the cost of providing the service.

• Clarifies the Motor Vehicle Allowance to state that only one vehicle per facility is allowed as a Routine Cost Component.

• Removes language stating that allowable costs not specified for inclusion in another cost category shall be included in the Fixed Costs Component as those costs fall under the Routine Cost Component, not the Fixed Costs Component.

• Principle 18.5.1(Interest Expense) The Department made two changes: (1) Added clarifying language that Interest Expenses must be for a purpose related to patient care; and (2) Added a new provision (f)  with clarifying language that loan principal payments need to be applied to the allowable portion of debt first, consistent with CMS The Provider Reimbursement Manual, Part I, Chapter 2 (Interest Expense), Publication #15-1. 

• Principle 18.12 (Payment for High MaineCare Utilization): The Department made two changes:  (1) Clarifies that Payment for High MaineCare Utilization is based on the number of resident days and not the number of residents; and (2) Added a new provision, with a retroactive effective date of July 1, 2021, pursuant to Resolves 2021, ch. 171, so that any nursing facility whose  MaineCare resident days constitute  more than 80% of the nursing facility’s total number of resident days will receive a High MaineCare Utilization Payment of $0.60 per resident day  for each one percentage of MaineCare resident days above 80%, and this payment is not subject to cost settlement and must be retained by the nursing facility in its entirety. 

• Principle 22.3.4.3 (Add On to Support Essential Support Worker):  In compliance with 22 M.R.S. Section 7402 (Essential support worker reimbursement), the Department added a new provision which creates an Essential Support Worker Add-On reimbursement to the direct care rate to increase cost reimbursement caps as necessary to enable providers to cover labor costs for essential support workers as defined in 22 M.R.S. Section 7401(3) that equals at least 125% of the minimum wage established in 26 M.R.S. Section 664(1), and by increasing related taxes and benefits accordingly. This add-on is not case mix adjusted. Pursuant to P.L. 2021, ch. 398, Sec. AAAA-5, this additional reimbursement has a retroactive effective date of July 1, 2022. 

• Changes the facility allowance to receive an annual inflation adjustment based on the Consumer Price Index under the Prospective Per Diem Rate for Rates for Facilities Recently Sold, Renovated or New Facilities.

• Eliminates the requirement that Remote Island Nursing Facilities must maintain Medicaid utilization of ninety-five percent or more.

• Principle 44 (Special Wage Allowances):  The Department made the following changes:  In compliance with P.L. 2019, ch. 533, the Department added a provision for Special Wage Allowances for January 1, 2020 to June 30, 2021 to provide for wages and wage-related benefits in both the direct care cost component and route care cost component. This reimbursement has been approved by CMS.  The rule also notes that a Special Wage Allowance for the period January 1 through June 30, 2022, was authorized and reimbursed under the Section 67 Principle 34 Extraordinary Circumstances Allowance. Note that, consistent with P.L. 2019, ch. 533, Sections 1, 2 and 3, the Special Wage Allowance is not continued past the January 1 through June 30, 2022 period because the rebasing required under 22 M.R.S. Section 1708(3)(F) is based on 2020 or a later calendar year as a base year and the rebased rates have incorporated the costs of contract labor, wages and allowable benefits and taxes that were reported on each nursing facility’s cost report for its fiscal year ending in calendar year 2020.

• Makes other, non-substantive grammatical corrections.

See http://www.maine.gov/dhhs/oms/rules/index.shtml  for rules and related rulemaking documents.

EFFECTIVE DATE:                      November 26, 2023

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