Section 97, Private Non-Medical Institution (PNMI) Appendix E - Direct Care Cost Guidance for Budget Submissions and Audit Settlement Process
This notice contains guidance for providers of Section 97, Appendix E, PNMI regarding allowable direct care costs in budget submissions and during the Audit Settlement Process.
Allowable Costs
MaineCare Benefits Manual (MBM), Chapter III, Section 97, Appendix E, § 2400 defines allowable costs.
Direct care services are covered services, as defined in MBM, Ch. II, Section 97, and must be delivered by an allowable staff directly to a member served by the PNMI.
Additionally, per MBM, Chapter II, Section 97.08, allowable direct care services include the supervisory and training activities that are necessary to appropriately deliver PNMI Services.
Direct care staff costs must meet the above-stated criteria for a provider to include them on Schedule C of the budget form when they submit a request to change facility budgets.
Non-Allowable Costs
Any costs not specified in § 2400 are non-allowable costs. Non-allowable costs include, but are not limited to, staff time not spent delivering a direct care service. The provider may only claim the portion of the staff person’s salary attributable to the delivery of direct care services, including the training and supervision necessary to provide those services, as a direct care cost. The remaining portion of the salary must be recorded as a program cost outside of the direct care costs Schedule C in the budget form submission.
Direct care supervision and training of staff must be limited to activities directly related to carrying out PNMI Services. Costs that do not meet this standard may not be classified as direct care.
Costs for staff positions including, but not limited to, directors, quality assurance personnel, maintenance staff, or regional supervisory staff are non-allowable as direct care costs and must not be included under the direct care schedule of the budget form. However, these costs may remain as program costs elsewhere in the budget submission.
Upon provider submission of a budget form for consideration by the Department, MaineCare’s Rate Setting Unit will review all costs for direct care staff and training listed on the Schedule C of the budget form for compliance with MaineCare policy. The Department will remove costs included on Schedule C that it determines are unallowable and add them to Schedule B of the budget form to remain as program costs.
During the audit process, the Division of Audit will remove any unallowable costs included as direct care costs in the annual cost report submitted to the Department. As a result, providers who currently have non-allowable direct care costs included in their budgets may face recoupment at cost settlement.
If a provider is concerned their budget may include non-allowable direct care costs, please contact Amanda Lee, MaineCare’s Rate Setting Coordinator, with questions and to have their current approved budget reviewed and potentially adjusted.
Rate adjustments implemented prior to cost settlement will distribute any fiscal impact over time, preventing the provider from facing a larger, one-time adjustment at the time of cost settlement.