MaineCare - Forms

 

Here are the updated cost reports with the latest policy changes:

icf mr cost rpt 1-01-11 & after.xls

icf mr cost rpt instr 1-01-11 & after.doc

checklist icfmr12.doc

nf cost rpt beg on or after 6-30-12.xls

nf cost rpt beg on or after 6-30-14.xls

nf cost rpt instr beg on or after 6-30-12.doc

nf cost rpt instr beg on or after 6-30-14.doc

checklist nf12.doc

 

rcf ML PNMI app c CM cst rpt 6-30-12 & after.xls

rcf ML PNMI app c CM cst rpt instr 6-30-12 & after.doc

rcf PNMI app f cst rpt 6-30-12 & after.xls

rcf PNMI app f cst rpt instr 6-30-12 & after.xls

rcf PNMI All app r cst rpt instr 6-30-10 & after.doc

rcf PNMI app c CM cst rpt 6-30-12 & after.xls

rcf PNMI app c CM cst rpt instr 6-30-12 & after.doc

checklist-rcf12.doc

 

PNMI cost report Eff6-30-12.xls

PNMI cost report instr. Eff6-30-12.doc

Checklist PNMI 12.doc

This cost report is for PNMI Appendix E Providers that are still subject to a final cost settlement. This PNMI cost report is also for Appendix B Providers that are transitioning from a cost settled program to a fee-for-service program with an operating period that began prior to November 15, 2010.

PNMI fee for service cost report Eff080109.xls

PNMI fee for service cost report Inst. Eff080109.doc

Checklist fee for service PNMI2010.doc

Private Non-Medical Institutions (PNMI) Fee-For-Service Cost Report:

This is a new cost report for PNMI Appendix D Child Care Facilities that converted from a cost settled program to a fee-for-service (FFS) program with no cost settlement. The effective date for the conversion of PNMI Appendix D Providers to FFS was August 1, 2009. This cost report must be filed by PNMI Appendix D providers for fiscal years beginning on or after August 1, 2009. PNMI Appendix B Substance Abuse Treatment Facilities also converted from a cost settled program to a fee-for-service (FFS) program with no cost settlement. The effective date for the conversion of PNMI Appendix B Providers to FFS was November 15, 2010. This cost report must be filed by PNMI Appendix B providers for fiscal years beginning on or after November 15, 2010.

If you have any issues downloading the cost reports please contact:

 

 

 

 

 

 

 

 

 

 

Steve Baird

E-mail:  steve.l.baird@maine.gov

Phone: (207) 287-2799