MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter 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 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 Rulemaking 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 (DHHS), Office of 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
PROPOSED RULE NUMBER:
CONCISE SUMMARY: The Department of Health and Human Services proposes these rule changes in 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities. On February 1, 2025, the Department enacted changes to this policy through emergency rulemaking pursuant to Title 5, M.R.S. §8054.
The Department’s principal purpose of this rulemaking is to make permanent the establishment of a 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.
STATUTORY AUTHORITY: 22 M.R.S. § 42, 3173-J; P.L. 2023, CH. 643; 22 M.R.S § 1708; 22 M.R.S. § 7402
DATE, TIME, AND PLACE OF PUBLIC HEARING: Monday, March 10, 2025, 1:00 PM EST at 109 Capitol Street, Augusta, Maine 04333.
The Department has determined that its public hearing will be hybrid, conducted both in-person and remotely, via Zoom.
Zoom meeting link: https://mainestate.zoom.us/j/81377592832
Meeting ID: 813 7759 2832
One Tap Mobile: 1-309-205-3325
Find your local number: https://mainestate.zoom.us/u/kZXrAjXmH
Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to participate in the hearing contact the person listed for this filing 5 days in advance of the hearing.
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 Thursday, March 27, 2025.
AGENCY CONTACT PERSON: Derrick Grant, Policy Manager
AGENCY NAME: Office of 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. § 42, 3173-J; P.L. 2023, CH. 643; 22 M.R.S § 1708; 22 M.R.S. § 7402
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