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-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder
GENERAL PROVISIONS
Appendix 144-101-III-21-IIA - Weekly Hours Authorized per Facilit
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APPENDIX IIA |
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Weekly Hours Authorized per Facility |
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Home Support Agency per diem |
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Provider |
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Location Address |
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MaineCare Provider ID |
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Instructions |
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MaineCare Member |
Regular Support Hours up to 168 |
Hours in excess of 168 |
Medical Support Hours |
Total Support Hours (sum total of all types of support hours) |
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A |
Enter the weekly authorized support hours under each type by MaineCare member for this facility |
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B |
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C |
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D |
Sum of total weekly authorized support hours for all members in facility by type of support and total facility. |
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E |
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F |
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TOTAL weekly authorized support hours by each type |
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Regular Support Hours up to 168 |
Hours In Excess of 168 |
Medical Support Hours |
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Hourly Support reimbursement rates by type |
$32.13* |
$ $28.75* |
$ 38.69* |
Amount includes service provider tax expense. |
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Total Weekly Authorized amount for facility by type |
Total weekly authorized support hours multiplied by hourly support rate for each type |
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Number of days per week |
7 |
7 |
7 |
7 |
7 |
7 |
Seven (7) days in a week |
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Number of members in facility (1 to 6) |
Total number of members in facility that are authorized for service. For Medical Add on, it would only be the number of member in facility that are authorized for those types of services. |
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*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
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Total Authorized Per Diem (Daily) rate amount |
Total Weekly Authorized amount divided by number of days per week and then by the number for members in the facility for each type. |
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Total amount / Days / # of Consumers |
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*Maximum allowance effective 7/1/18.
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Providers are responsible for calculating all amounts payable to them in accordance with the above-listed rates and rate calculation formula. As an assistive tool, OMS provides sample calculations for each rate based on the number of weekly service hours provided and the number of members served. Calculation Tables 1& 2 are accessible through the DHHS website http://www.maine.gov/dhhs/oads/MaineCare/index.shtml. Providers may request paper copies of calculation Appendices IIA & IIB by calling OMS at 1-866-690-5585. TTY 711 THE DEPARTMENT EXPRESSLY DISCLAIMS THE ACCURACY OF THE CALCULATIONS TABULATED IN Appendix IIA & IIB AND EXPRESSLY DISCLAIMS ANY AND ALL LIABILITY FOR LOSSES, INCURRED COSTS, OR OTHER DETRIMENT SUFFERED BY ANY PROVIDER AS A RESULT OF RELIANCE UPON INFORMATION CONTAINED IN Appendix IIA & IIB. Appendix IIA is for members Authorized with Regular service, Appendix IIB is for members authorized with Medical Add On service. |
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MaineCare Member |
Regular Support Rate up to 168 |
Hours in excess of 168 |
Medical Support Rate |
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A |
The total authorized per diem (daily) rate by member |
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B |
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C |
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D |
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E |
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F |
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