Subsection 144-101-III-97-2400 - ALLOWABILITY OF COST2400.1 Allowable costs shall include salaries and wages for direct service staff. See applicable Appendix for each type of PNMI for the list of approved direct service staff:
Appendix B Substance Use Treatment Facilities
Appendix C Medical and Remedial Service Facilities
Appendix D Children's Residential Care Facilities
Appendix E Community Residences for Persons with Mental Illness
Appendix F Non-Case Mixed Medical and Remedial Facilities
2400.2 Allowable costs shall also include the following taxes and benefits applicable to direct service staff as defined in the applicable Appendix: Payroll taxes/unemployment payroll taxes
Health insurance
Dental insurance
Employer term life/disability insurance
Qualified retirement contributions
Worker's Compensation insurance
2400.3 The Department will approve the direct care staffing.2400.3.1 The Department will determine the reasonableness of costs based on the budget submitted prior to the beginning of the provider's fiscal year, subject to final approval by the Office of MaineCare Services and the Department. The total amount approved in the budget will serve as a cap for reimbursement.2400.3.2 A Rate Letter will inform the provider of the approved total cost cap and per diem rate based on a review of the submitted budget per Section 2400, Chapter III, General Provisions. For case mix facilities covered under Appendix C, the rate letter informs the agency of the Industry Price and Average Case Mix Index.2400.4 Allowable costs may also include contract fees, which are fees paid in lieu of salary, paid for use of foreign exchange fellows, such as those participating in the ILEX international professional exchange program for social workers, in lieu of direct service staff as defined in the applicable appendix. Contract fees must be prior-approved by the Department, and must meet all staff qualifications. The Department will reimburse the provider for the contract fee, based on a calculation of hours worked by the foreign exchange fellow, at the salary, wages and taxes and benefits that would be allowable under these regulations for a comparable direct service staff working those hours. The Department will only reimburse up to the allowed contract fee amount, and will not reimburse any wages and benefits to the foreign exchange fellow other than reimbursing the allowable contract fee amount.2400.5 Pending CMS approval, effective August 1, 2018, for the state fiscal year ending June 30, 2019, a special supplemental wage allowance shall be available to Appendix C PNMIs, for increases in wages and wage-related benefits in direct care and personal care cost components. An amount equal to ten percent (10%) of wages and associated benefits and taxes as reported on each facility's as-filed cost report for its fiscal year ending in calendar year 2016 shall be added to the cost per resident day in calculating each facility's prospective rate, notwithstanding any otherwise applicable caps or limits on reimbursement. This supplemental allowance shall be allowed and paid at final audit to the full extent that it does not cause reimbursement to exceed the facility's allowable costs per day each cost component that is settled in that fiscal year. 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.
2410 State-Mandated Service Tax: Effective 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, as defined in 36 M.R.S.A. §2552(1)(G).2420 Program Allowance: See the applicable Appendix for the allowable program allowance. The maximum reimbursement amount allowed, including the program allowance, will not be greater than the total costs of the program.2430 Certifying Other Qualified Staff (With exception for Appendix C and F facilities) Training and experience requirements of other qualified staff may vary by definition. However, in all cases, other qualified staff including exchange fellows must be certified or approved by a specified State agency, or its designee, as meeting these requirements. (The specified State agency, or its designee, would be the agency approving the staff for the facility.) These certifications/approvals must be on file. The approval must be in writing and dated at the time the approval is made. This approval process must not be delegated to a provider. The PNMI provider may certify to the approving agency that employees have or will have the requisite training. However, the approving agency must provide the written approvals for the provider to maintain on file. MaineCare payments made for individuals who have not been approved provisionally or fully certified by the State agency, or its designee, are subject to recoupment.2440 If these Principles do not set forth a determination of whether or not a cost is allowable or sufficiently define a term used, reference will be made first to the Medicare Provider Reimbursement Manual (HIM-15) guidelines followed by the Internal Revenue Service Guidelines in effect at the time of such determination if the HIM-15 is silent on the issues.2450 Pending CMS approval, effective retroactive to November 1, 2017, Appendix C and F PNMIs that experience unforeseen and uncontrollable events during a year that result in unforeseen or uncontrollable increases in expenses, defined more specifically in the applicable Section 97 appendices, may request an adjustment to a prospective rate in the form of an extraordinary circumstance allowance (ECA).2460 Pending CMS approval, effective retroactive to November 1, 2017, costs incurred by Appendix C and F PNMIs 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 rate until the Department adjusts for the direct care and personal care services rates, as applicable, to fairly and properly reimburse facilities for these costs.2470 Temporary High Intensity Staffing Services are reimbursed based on a direct care price. This direct care price is not subject to audit. The Temporary High Intensity Staffing Services remittances received will be removed from the total Direct Services Staff costs in determining the allowable cost for the PNMI rehabilitation and personal care direct service staff costs. C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-97, subsec. 144-101-III-97-2400