Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-67 - Nursing Facility Services
Subsection 144-101-II-67.06 - REIMBURSEMENT
Universal Citation: 10 ME Code Rules ยง 144-101-II-67.06
Current through 2024-38, September 18, 2024
A. Nursing facilities are reimbursed in accordance with this Section, Chapter III, Principles of Reimbursement for Nursing Facilities.
1. Except for nursing
facilities which provide acquired brain injury services, reimbursement for
ancillary services, including those provided by a NF that is a distinct part of
a larger institution, such as medical supplies, physical therapy, occupational
therapy, speech and hearing services, respiratory therapy, and pharmacy
services is based upon reasonable cost or the maximum allowance.
2. Acquired Brain Injury (ABI) services shall
be reimbursed pursuant to the "Intensive Rehabilitation NF Services for Brain
Injured Individuals" section of the Principles of Reimbursement only when:
a) the member is classified, by the
Department or its Authorized Entity, NF-ABI level pursuant to Section 67.02-5
and all relevant requirements;
b)
the services were provided during an approved NF-ABI classification period; and
c) the ABI services were delivered
in a CARF accredited facility (unless waived by the Department for an
authorized out-of-state placement), and pursuant to Section 67.05-1
3(H).
3. Nursing
facilities will be reimbursed under Chapter 115, Principles of Reimbursement
for Residential Care Facilities, for those members qualifying for continued NF
stay under Section 67.02-9.
B. In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek from any other sources payment for the rendered service prior to billing the MaineCare Program.
C. Nursing Facilities may not accept or receive payment for covered services in addition to the MaineCare payment.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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