10-144-101 Me. Code R. § III-97-C-2400
The case mix adjusted price includes services provided by the direct care services staff listed below. Allowable costs include salaries, wages, benefits, and consultant fees for direct care staff and services listed below:
Clinical consultant services
Licensed practical nurse services
Licensed social workers or other social worker services
Personal care services staff
Practical nurses
Registered nurse consultant services, and
Other qualified medical and remedial staff.
A program allowance of thirty-five (35) percent, expressed as a percentage of the allowable costs, as defined in Chapter III, Section 97, Sections 2400.1 and 2400.2 will be allowed in lieu of indirect and/or PNMI related cost.
Effective July 1, 2002, personal care services not included in the case mix adjusted price include salaries, wages, and benefits (as described in Chapter III, Section 2400.2) for direct care staff listed below:
Laundry
Housekeeping, and
Dietary services
The personal care services component is determined by inflating the facility's 1998 audited costs for these services to June 30, 2003. This becomes the PNMI's facility specific cap. The actual allowable personal care services costs will be settled at audit up to this cap.
The increases in wages and wage-related benefits set forth in 2400.5 in the "Main Rule" and 2400.9 in this Section shall not be included in the PNMI facility's personal care services cost caps.
Allowable costs will also include the contract fee paid for use of exchange fellows in lieu of direct service staff as defined in the applicable appendix. Contract fees must be prior-approved by the seeding Department. The contract fee paid cannot exceed the normal salary plus benefits and taxes for comparable direct service staff within the provider agency.
As of July 1, 2004, allowable costs shall include a State-mandated service tax. The State-mandated service tax is a tax on the value of PNMI services pursuant to 36 M.R.S. §2552.
Eligible facilities will be allowed to retain the "remote island facility" supplemental payment, representing a fifteen (15) percent rate increase, in addition to the total allowable rate for Private Non-Medical Institution direct care services and personal care services costs otherwise determined under these rules.
Pending CMS approval, effective retroactive to November 1, 2017, facilities which experience unforeseen and uncontrollable events during a year that result in unforeseen and uncontrollable increases in expenses, as defined herein, may request an adjustment to a prospective rate in the form of an extraordinary circumstance allowance (ECA).
Unforeseen means that a provider did not have sufficient notice of the change to make changes to their operations that would have avoided the cost of the event.
Uncontrollable means that the event occurred as a result of forces unrelated to the discretionary management authority exercised by the provider's organization. Business decisions are not considered uncontrollable.
ECA may include, but are not limited to:
* Events of a catastrophic nature (fire, flood, etc.);
* Unforeseen increase in minimum wage, Social Security, or employee retirement contribution expenses in lieu of Social Security expenses;
* Change in number of licensed beds;
* Changes in licensure or accreditation requirements.
If the Department concludes that an ECA existed, and the increased costs are considered reasonable and necessary, an adjustment will be made by the Department in the form of a supplemental allowance.
The Department will determine from the nature of the ECA whether it would have a continuing impact and therefore whether the allowance should be included in the computation of the base rate for the succeeding year. Reimbursement to a residential care facility for additional costs arising from ECA must be paid via a supplemental payment that is added to the per diem reimbursement rate until the Department adjusts the direct care and personal care services rates, as applicable, to fairly reimburse a facility for these costs.
A request for ECA must be made in writing and addressed to:
Department of Health and Human Services
Director of Rate-setting
11 State House Station
Augusta, ME 04333
The written request must include:
The Department may require additional documentation to review and process the ECA request. A facility requesting an ECA shall provide all documents requested by the Department. The Department shall deny any ECA requests from facilities who refuse to supply requested documentation.
Pending CMS approval, effective retroactive to November 1, 2017, costs incurred by a residential care facility to comply with changes in federal or state laws, regulations, and rules or local ordinances and not otherwise specified in rules adopted by the Department are considered reasonable and necessary costs. Reimbursement for these additional regulatory costs will be paid via a supplemental payment that is added to the per diem reimbursement rate until the Department adjusts the direct care and personal care services rates, as applicable to fairly and properly reimburse a facility for these costs.
Requests for adjustments must be made in writing and addressed to:
Department of Health and Human Services
Director of Rate-Setting
11 State House Station
Augusta, ME 04333
The Department may deny or modify the adjustment request based on documentation provided for review. The Department will provide written notification of adjustment request determination.
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 to the Department upon request.
10-144 C.M.R. ch. 101, § III-97-C-2400