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 III - Allowances for Services
Section 144-101-III-107 - Principles of Reimbursement for Psychiatric Residential Treatment Facility Services
Subsection 144-101-III-107-25 - FINAL AUDIT OF INTERIMRATES

Universal Citation: 10 ME Code Rules § 144-101-III-107-25

Current through 2024-38, September 18, 2024

25.1 Principle. All facilities will be required to submit a cost report in accordance with Principle 13.2 at the end of their fiscal year on cost report forms approved by the Department. The Department will conduct a final audit of each facility's cost report, which may consist of a full scope examination by Department personnel and which will be conducted on an annual basis.

25.2 Upon final audit of the facility's cost report for the first and subsequent years prospective years, the Department will:

25.2.1 Determine the actual allowable fixed costs incurred by the facility during the cost reporting period;

25.2.2 Determine the actual allowable routine costs incurred by the facility during the cost reporting period;

25.2.3 Determine the occupancy levels of the PRTF;

25.2.4 Calculate a final rate; and

25.2.5 Determine final settlement by calculating the difference between the audited final rate and the interim rate(s) paid to the provider times the MaineCare utilization. PRTFs that transfer a cost center from one (1) cost component to another cost component resulting in increased MaineCare costs will have the affected cost components adjusted at time of audit.

Upon final audit of a facility's cost report, the Department will calculate a final prospective rate and determine the lump sum settlement amount either due to or from the PRTF.

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