Implementation of January 1, 2023, Rate Study Increases for Section 2, Adult Family Care Homes (AFCH), CR 116777
As of today, April 19, 2023, updated rates for Section 2, AFCH are now available for billing in MIHMS. These changes will be effective retroactively to January 1, 2023, and are a result of our recent rate study conducted in relation to P.L. 2021 Ch.398, Part AAAA. We have posted new rates to the MIHMS Provider Fee Schedule that will apply to services provided on or after, January 1, 2023.
To determine the appropriate rate for each member, providers must identify the resource group in addition to the size and type of AFCH home in which the member resides.
Please bill the appropriate rates under revenue code 3104, as listed below.
|
6 Bed or Fewer Facility |
7 and 8 Bed Facility |
||||||
|
Resource Group |
MaineCare Weight |
Resource Adjusted Price |
Based on $126.89 Unadjusted Price multiplied by MaineCare Weight |
Resource Group |
MaineCare Weight |
Resource Adjusted Price |
Based on $100.76 Unadjusted Price multiplied by MaineCare Weight |
|
1 |
1.657 |
0.00 |
$210.26 |
1 |
1.657 |
0.00 |
$166.96 |
|
2 |
1.210 |
0.00 |
$153.54 |
2 |
1.210 |
0.00 |
$121.92 |
|
3 |
1.360 |
0.00 |
$172.57 |
3 |
1.360 |
0.00 |
$137.03 |
|
4 |
1.027 |
0.00 |
$130.32 |
4 |
1.027 |
0.00 |
$103.48 |
|
5 |
0.924 |
0.00 |
$117.25 |
5 |
0.924 |
0.00 |
$93.10 |
|
6 |
0.804 |
0.00 |
$102.02 |
6 |
0.804 |
0.00 |
$81.01 |
|
7 |
0.551 |
0.00 |
$69.92 |
7 |
0.551 |
0.00 |
$55.52 |
|
8 |
0.551 |
0.00 |
$69.92 |
8 |
0.551 |
0.00 |
$55.52 |
|
Remote Island 6 Bed or fewer Facility
|
Remote Island 7 and 8 Bed Facility
|
||||||
|
Resource Group |
MaineCare Weight |
Resource Adjusted Price |
Based on $145.92 Unadjusted Price multiplied by MaineCare Weight |
Resource Group |
MaineCare Weight |
Resource Adjusted Price |
Based on $115.87 Unadjusted Price multiplied by MaineCare Weight |
|
1 |
1.657 |
0.00 |
$241.79 |
1 |
1.657 |
0.00 |
$192.00 |
|
2 |
1.210 |
0.00 |
$176.56 |
2 |
1.210 |
0.00 |
$140.20 |
|
3 |
1.360 |
0.00 |
$198.45 |
3 |
1.360 |
0.00 |
$157.58 |
|
4 |
1.027 |
0.00 |
$149.86 |
4 |
1.027 |
0.00 |
$119.00 |
|
5 |
0.924 |
0.00 |
$134.83 |
5 |
0.924 |
0.00 |
$107.06 |
|
6 |
0.804 |
0.00 |
$117.2 |
6 |
0.804 |
0.00 |
$93.16 |
|
7 |
0.551 |
0.00 |
$80.40 |
7 |
0.551 |
0.00 |
$63.84 |
|
8 |
0.551 |
0.00 |
$80.40 |
8 |
0.551 |
0.00 |
$63.84 |
We will reimburse claims submitted on or after April 19, 2023, at the new rates.
If you submitted claims between January 1, 2023, and April 18, 2023, please adjust your claims at the new rates.
If you have questions related to billing, please contact Bruce Cosgrove, Provider Relations Specialist. For questions related to this rate determination, please contact Jessica Levesque, MaineCare Rate Setting Project Manager.
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