MaineCare - Rules

NOTICE: Please check the Proposed, emergency and recently adopted rules link for the most recent updates first.

 

DHHS Chapter 101 MaineCare Benefits Manual  This link connects you to the links for the various Principles of Reimbursement for the cost settled MaineCare programs listed below:

Principles of Reimbursement for Nursing Facilities (word*)

Principles of Reimbursement for Hospital Services (word*)

Private Non-Medical Institutions (PNMIs):
Rules for Appendices B, D, & E PNMI Facilities:
Private Non-Medical Institution Services (word*)
Appendix B Substance Abuse Treatment Facilities (word*)
Appendix D Child Care Facilities (word*)
Appendix E Community Residences For Persons With Mental Illness (word*)


Rules for Appendices C & F PNMI Residential Care Facilities (RCFs):
Private Non-Medical Institution Services (word*)
Appendix C Medical and Remedial Service Facilities (word*)
Appendix F Non-Case Mixed Medical and Remedial Facilities (word*)

Principles of Reimbursement for Residential Care Facilities - Room and Board Costs (word*)

Intermediate Care Facilities for the Mentally Retarded (ICF/MRs) (word*)

When the MaineCare Benefits Manual is silent on an audit issue the Medicare Provider Reimbursement Manual (PRM) is necessary. 
Medicare Rules


*free viewer or to request a hard copy