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-2 - Adult Family Care Services
Providers will be reimbursed the resource-adjusted price for each member according to the resource group the member is assigned as a result of the MDS-ALS assessment. The Department will reimburse updated resource adjusted prices twice each year upon reassessments as detailed in Chapter II, Section II. Effective July 1, 2019, payment rates attributable to wages and salaries for personal care and related services will be increased annually by an inflation adjustment cost-of-living percentage in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index, Medical Care Services index from the prior December for professional services, nursing home and adult day care services. Those cost of living increases shall continue annually until the Department has completed a rate study for adult family care services and the rates in the rate study have been implemented. Providers must bill using the UB-92 and according to "Billing Instructions for Adult Family Care Services."
|
Description |
Maximum Allowance |
|
Adult Family Care Services |
Resource-Adjusted Price, determined by Resource group assignment as a result of MDS-ALS Assessment |
The Department is seeking and anticipates receiving Centers for Medicare and Medicaid Services(CMS) approval for this Section. Pending approval, increased rates will be as follows:
|
Resource Group |
MaineCare Weight |
Resource Adjusted Price** (Based on $46.79 Unadjusted Price Multiplied by MaineCare weight) Effective 7/1/16 to 6/30/17 |
Resource Adjusted Price** (Based on $48.43 Unadjusted Price Multiplied by MaineCare weight) Effective Retroactive to 7/1/17 |
Resource Adjusted * Price*** (Based on $53.71 Unadjusted Price Multiplied by MaineCare weight) Effective Retroactive to 8/1/18 |
Resource Adjusted * Price*** (Based on $55.29 Unadjusted Price Multiplied by MaineCare weight) Effective 7/1/19 |
|
1 |
1.657 |
$77.53 |
$80.24 |
$89.00 |
$91.62 |
|
2 |
1.210 |
$56.62 |
$58.60 |
$64.99 |
$66.90 |
|
3 |
1.360 |
$63.63 |
$65.86 |
$73.05 |
$75.19 |
|
4 |
1.027 |
$48.05 |
$49.73 |
$55.16 |
$56.78 |
|
5 |
.924 |
$43.23 |
$44.75 |
$49.63 |
$51.09 |
|
6 |
.804 |
$37.62 |
$38.94 |
$43.18 |
$44.45 |
|
7 |
.551 |
$25.78 |
$26.68 |
$29.60 |
$30.47 |
|
8 |
.551 |
$25.78 |
$26.68 |
$29.60 |
$30.47 |
Remote Island Facility Supplemental Payment: If CMS approves, effective October 1, 2015, Remote Island Facilities are entitled to a supplemental payment of fifteen (15) percent in addition to the standard MaineCare reimbursement rate, as set forth in Chapter III. Eligible facilities are allowed to retain this supplemental payment in addition to the total allowable rate under these rules.
|
Resource Group |
MaineCare Weight |
Resource Adjusted Price** (Based on $51.74 Unadjusted Price Multiplied by MaineCare Weight) Effective 10/1/15-6/30/16 |
Resource Adjusted Price** (Based on $53.81 Unadjusted Price Multiplied by MaineCare Weight) Effective 7/1/16 to 6/30/17 |
Resource Adjusted Price** (Based on $55.69 Unadjusted Price Multiplied by MaineCare Weight) Effective Retroactive to 7/1/17 |
Resource* Adjusted Price*** (Based on $61.76 Unadjusted Price Multiplied by MaineCare Weight) Effective Retroactive to 8/1/18 |
|
1 |
1.657 |
$85.73 |
$89.16 |
$92.28 |
$102.34 |
|
2 |
1.210 |
$62.60 |
$65.11 |
$67.39 |
$74.73 |
|
3 |
1.360 |
$70.36 |
$73.18 |
$75.74 |
$83.99 |
|
4 |
1.027 |
$53.14 |
$55.26 |
$57.19 |
$63.43 |
|
5 |
0.924 |
$47.81 |
$49.72 |
$51.46 |
$57.07 |
|
6 |
0.804 |
$41.60 |
$43.26 |
$44.78 |
$49.66 |
|
7 |
0.551 |
$28.51 |
$29.65 |
$30.69 |
$34.03 |
|
8 |
0.551 |
$28.51 |
$29.65 |
$30.69 |
$34.03 |
|
Resource Group |
MaineCare Weight |
Resource* Adjusted Price*** (Based on $63.59 Unadjusted Price Multiplied by MaineCare Weight) Effective 7/1/19 |
|
1 |
1.657 |
$105.37 |
|
2 |
1.210 |
$76.94 |
|
3 |
1.360 |
$86.48 |
|
4 |
1.027 |
$65.31 |
|
5 |
0.924 |
$58.76 |
|
6 |
0.804 |
$51.13 |
|
7 |
0.551 |
$35.04 |
|
8 |
0.551 |
$35.04 |
*The increase in rates for services effective August 1, 2018 and July 1, 2019 must be attributed directly to the wages and salaries of the professional staff delivering the personal care and related services to members.
** The Department is seeking and anticipates receiving approval from CMS for these rates. Pending approval of the request, the rates will be effective as noted.
*** The Department is seeking and anticipates receiving approval from CMS for these rates. Pending approval of the request, the rates will be effective as noted.
