10-144-101 Me. Code R. § III-97-B-6000

Current through 2024-51, December 18, 2024

Section 144-101-III-97-B-6000 - RATE SETTING

6000.1 The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for this Section. Pending approval, the following reimbursement rates will be effective retroactive to July 1, 2016* and August 1, 2018*** as indicated below:

The following capitated rates apply to Appendix B services.

SERVICE DESCRIPTION	AMOUNT Effective 7/1/19	AMOUNT Effective 11/1/21*	UNIT
Medically Supervised Withdrawal Services (Non Hospital based)	$217.48	$385.55	per diem
Medically Supervised Withdrawal Services (Non Hospital based - exception rate for low RN	$238.12	per diem
Halfway House services	$106.09	$165.67	per diem
Extended Care	$116.89	$137.21	per diem
Residential Rehabilitation Type I	$224.44	$287.91	per diem
Residential Rehabilitation Type II	$119.65	$165.67	per diem
Adolescent Residential Rehabilitation	$187.67	$254.78	per diem
Personal Care Substance Use (Substance Use Shelter Services)	$56.87	$56.87	per diem

The Department shall seek approval from CMS for this Section (for the rates * above).

Members are assessed as described in Chapter II, Section 97, and assigned to one of the types of substance use treatment services described above. Providers bill the Department on a per diem basis for each member receiving service. The capitated rate includes all PNMI services required by the member for his or her type of service including all staffing required pursuant to State of Maine licensing guidelines and as identified in the members individual service plan. There is no cost settlement for Appendix B PNMI services.

6000.2 The provider must submit, upon request, such data, statistics, schedules, or other information required by the OMS and OBH.

6000.3 The standardized rate for each Substance use treatment service type will begin November 15, 2010.

6000.4 Providers must ensure that the increase in reimbursement rates effective August 1, 2018 is applied in full to wages and benefits for employees who provide direct services. Providers must document compliance with this requirement in their financial records and provide such documentation upon request. The increase must be granted or paid out retroactively from the date the Department begins reimbursing the increased rates.

10-144 C.M.R. ch. 101, § III-97-B-6000