MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services, Appendix C

Date posted: Dec 28, 2023

Attachment(s):

Methodology Notice PNMI C HMU

Notice of MaineCare Reimbursement Methodology Change

AGENCY: Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 97, Private Non-Medical Institution Services, Appendix C

NATURE OF PROPOSED CHANGES: Effective January 1, 2024, the Department plans to provide funding for a High MaineCare Utilization (HMU) add-on payment to Private Non-Medical Institutions (PNMI) that care for residents who are older or disabled (Appendix C). Facilities with MaineCare days constituting between seventy percent (70%) and eighty percent (80%) of total days across all payers will receive a HMU payment of $0.40 per diem for each one percent (1%) of MaineCare days between seventy percent (70%) and eighty percent (80%). Facilities with MaineCare days constituting more than eighty percent (80%) of total days across all payers will receive a HMU payment of $0.60 per diem for each one percent (1%) of MaineCare days above eighty percent (80%).

REASON FOR PROPOSED CHANGES: All changes are to provide funding for a high MaineCare utilization add-on payment to Private Non-Medical Institutions (PNMI) that care for residents who are older or disabled (Appendix C).

ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $1,936,835 in federal fiscal year 2024 which includes $1,213,427 in federal funds and $723,408 in state funds, and will cost $2,582,447 in federal fiscal year 2025 which includes $1,602,667 in federal funds and $979,780 in state funds.

ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location.

CONTACT INFORMATION FOR RECEIPT OF COMMENTS: Kristin Merrill

Kristin.Merrill@maine.gov

AGENCY NAME: Office of MaineCare Services

ADDRESS: 109 Capitol Street, 11 State House Station

Augusta, Maine 04333-0011

TELEPHONE:(207) 624-4006 FAX: (207) 287-6106

TTY: 711 Maine Relay (Deaf or Hard of Hearing)

See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

Office: MaineCare Services

Comment deadline: Jan 04, 2024