C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-43, subsec. 144-101-II-43.09
REVENUE CODE | HCPC CODE | DESCRIPTION OF SERVICES | UNITS OF SERVICE |
0651 | T2042 | Routine Home Care | Per Diem |
0551 | G0299 | Service Intensity Add-On (direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting | Per 1/4 Hour |
0561 | G0155 | Service Intensity Add-On (services of a clinical social worker in the home health or hospice setting | Per 1/4 Hour |
0652 | T2043 | Continuous Home Care | Per Hour |
0655 | T2044 | Inpatient Respite Care | Per Diem |
0656 | T2045 | General Inpatient Care | Per Diem |
0657 | Appropriate CPT Code | Physician Services non hospice services | N/A |
Specific reimbursement rates are listed on the MaineCare Provider Fee Schedule, which is posted on the Department's web site in accordance with 22 M.R.S. Sec.3173-J(7).
Rates for Routine Home Care services, both days 1-60 and days over 60, are reimbursed at 123% of the CMS published Medicaid rates, effective October 1 annually, plus an adjustment for regional differences in wages using the hospice wage index.
Continuous Home Care, Inpatient Respite Care, General Inpatient Care and the Service Intensity Add-On services are reimbursed at 100% of the CMS published Medicaid rates, effective October 1 annually, plus an adjustment for regional differences in wages using the hospice wage index.
Hospice providers will be reimbursed a per diem amount to cover room and board services provided by the nursing facility (NF) or intermediate care facility for individuals with intellectual disabilities (ICF-IID) for MaineCare members who have elected hospice care and reside in the NF or ICF-IID. This reimbursement rate is equal to 95 percent (95%) of the base rate paid to that particular facility of residence.
Failure by a hospice provider to comply with the Medicare quality reporting requirements during each fiscal year will result in a two percent (2%) reduction to the market basket update applied prospectively to the following hospice rate year.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-43, subsec. 144-101-II-43.09