C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-67, subsec. 144-101-III-67-39

Current through 2024-51, December 18, 2024

Subsection 144-101-III-67-39 - COMMUNITY-BASED SPECIALTY NURSING FACILITY UNITS

Community-based specialty nursing facility units means providing medical-psychiatric services to former residents of the Riverview Psychiatric Center (formerly Augusta Mental Health Institute) and the Dorothea Dix Psychiatric Center (formerly Bangor Mental Health Institute (BMHI)) as well as other MaineCare members with qualifying mental disorders who have been deemed eligible by the Department or its Authorized Entity to receive these services. The Department shall designate specialty nursing facility units that provide medical-psychiatric services to former residents of the Riverview Psychiatric Center and the Dorothea Dix Psychiatric Center (BMHI). It has been determined that the reasonable cost of services for these residents, who have multiple medical needs that make them eligible for nursing facility level of care and have a primary diagnosis of mental disorder that requires the ongoing supervision of trained professionals, is an allowable cost. This requires the nursing facility unit to possess characteristics, both in terms of staffing and physical design, for providing services to these residents as approved, in writing, by the Office of Aging and Disability Services.

Such designated specialty units shall be subject to the provision of these rules, except for the rate limitations contained in Principles 22-27.

The Department will require that the facility obtain prior approval of its staffing pattern for the nursing and clinical staff associated with these facilities from the Office of MaineCare Services. In the event a facility believes that the needs of the residents it serves have increased or decreased, the facility must request prior approval from the Office of MaineCare Services authorizing such a change to its staffing pattern.

39.1Principle. A nursing facility that is recognized as a specialty unit under this Principle will be reimbursed for services provided to residents covered under the Title XIX program based upon the actual cost of services provided. The Department will establish the rate and determine that the cost is reasonable and adequate to be an efficiently and economically operated facility in order to provide care and services in conformity with applicable state and federal laws, regulations, and quality and safety standards.

39.2Cost. The Department's payments made for allowable services provided will be based on the actual allowable cost of services provided to such residents. The allowable per diem cost for the services will be increased annually by the rate of inflation at the beginning of each facility's fiscal year based on Principle 31. This per diem rate is subject to audit and will be adjusted to the actual allowable costs of providing services to such residents in these units at year end.

39.3Cost Reporting. Costs will be reported in a manner that will segregate the costs of such residents in the specialty unit from the costs of other residents in the unit and the standard nursing facility's costs as apply under these Principles.

For the purpose of calculating the reimbursement rate for such residents in the specialty unit, whether interim or final, a facility that has been designated as a specialty unit under this section of the Principles for a distinct part shall allocate the costs of such residents in the distinct part as if the distinct part were licensed as a separate level of care. All other sections of these Principles pertaining to the allowability, recording, and reporting of costs shall apply.

C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-67, subsec. 144-101-III-67-39