MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Ch. III, Section 67, Principles of Reimbursement for Nursing Facilities
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 Proposal. 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 Proposal
AGENCY: Department of Health and Human Services, Office of MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, Ch. III, Section 67, Principles of Reimbursement for Nursing Facilities
PROPOSED RULE NUMBER:
CONCISE SUMMARY: This rulemaking proposes the following changes in order to comply with various laws and add clarity:
- Removes language that stated the Department is seeking approval from CMS for changes where approval has been granted.
- 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.
- To comply with the Social Security Act, Section 1128J(d), changes from 50% to 100% the percentage of the amount owed that nursing facilities must pay when the Division of Audit determines, from the as-filed cost report, that the nursing facility owes money to the Department.
- 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.
- Changes “Uniform Desk Review” to “Cost Report Review and Acceptance” and makes changes to the associated requirements to clarify Audit’s review of cost reports for transparency and clarity. It removes the Department’s 365-day deadline for a Uniform Desk Review and adds a 45-day deadline for the Acceptance Review.
- 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.
- Adds “Purchased Central Office Services” to the list of Administration Functions under Routine Cost Components to clarify what costs in this category are allowable.
- 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.
- Clarifies under the Fixed Costs Component that Interest Expenses must be for a purpose related to patient care.
- Clarifies that loan principal payments need to be applied to the allowable portion of debt first, consistent with Medicare’s Principals of Reimbursement for Provider Costs Ch. 2, Section 200 (Interest Expense).
- Clarifies that Payment for High MaineCare Utilization is based on the number of resident days and not the number of residents.
- Effective July 1, 2021, under Payment for High MaineCare Utilization, eliminates the requirements that base year direct and routine aggregate costs per day be less than the median aggregate direct and routine allowable costs for the facility’s peer group, so that all facilities with MaineCare days constituting more than 80% of total days across all payers will receive a High MaineCare Utilization Payment of $0.60 per diem for each one percentage of MaineCare days above 80% per Resolves 2021, ch. 171, as the changes, consistent with 22 MRS 42(8), do not reduce or otherwise negatively affect the reimbursement or other payments that Section 67 provider and members are entitled to receive under the previously applicable rules.
- Creates an Essential Support Worker Add-On 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 the Maine Revised Statutes, Title 22, section 7401, subsection 3 to equal at least 125% of the minimum wage established in Title 26, section 664, subsection 1 and by increasing related taxes and benefits accordingly. This add-on will not be case mix adjusted.
- Changes the facility allowance to receive an annual inflation to an 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.
- Adds Special Wage Allowances for January 1, 2020 to June 30, 2021 and January 1, 2022 to June 30, 2022 to provide for wages and wage-related benefits in both the direct care cost component and route care cost component, as the changes, consistent with 22 MRS 42(8), do not reduce or otherwise negatively affect the reimbursement or other payments that Section 67 provider and members are entitled to receive under the previously applicable rules.
- Makes other, non-substantive grammatical corrections.
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173; P.L. 2021, ch. 398 § AAAA-5; Resolves 2021, ch. 171
DATE FILED WITH THE SECRETARY OF STATE’S OFFICE: June 13, 2023
DATE, TIME. AND PLACE OF PUBLIC HEARING: July 11, 2023, 09:00 AM Eastern Time (US and Canada) at 109 Capitol Street, Augusta, Maine.
This will be a hybrid public hearing. People that want to attend remotely can participate via Zoom.
Zoom Meeting Link: https://mainestate.zoom.us/j/82870925421?pwd=aXkwa3krc3Z4Nk5zUTIwRy9DcThhQT09
Meeting ID: 828 7092 5421
Passcode: 51339404
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Meeting ID: 828 7092 5421
Passcode: 51339404
Find your local number: https://mainestate.zoom.us/u/kb5NQsrKTB
In addition to the public hearing, individuals may submit written comments to DHHS by the date listed in this notice.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on July 24, 2023.
AGENCY CONTACT PERSON: Derrick Grant, MaineCare Policy
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: 207-624-6931 FAX: (207) 287-6106
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A
STATUTORY AUTHORITY FOR THIS RULE: 22 M.R.S.A, Ch 855 § 3173
SUBSTANTIVE STATE OR FEDERAL LAW BEING IMPLEMENTED (if different): P.L. 2021, ch. 398 § AAAA-5; Resolves 2021, ch. 171; Social Security Act § 1128J(d).
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