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-IIB - Weekly Hours Authorized & Billed per Facility
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APPENDIX IIB |
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Weekly Hours Authorized & Billed 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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Authorized billable Rate Calculator |
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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) |
Instructions |
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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 |
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E |
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F |
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TOTAL weekly authorized support hours by each type |
Sum of total weekly authorized support hours for all members in facility by type of support and total facility. |
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RANGE |
The range of allowable weekly hours is based on authorized hours with the lowest hours in range at 92.5% of total authorized hours and the highest hours in the range at 105% of the total authorized hours. |
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Lowest - 92.5% total weekly of Authorized Hours |
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Highest - 105% total weekly of Authorized Hours |
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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* |
$28.74* |
$ 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 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 members in facility that are authorized for those services. |
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Total Authorized Per Diem (Daily) rate amount |
Total Weekly Authorized amount divide 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
*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
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. Providers may request paper copies of calculation Appendices IIA & IIB Tables 1 & 2 are accessible through the DHHS website http://www.maine.gov/dhhs/oads/disability/ds/MaineCare/index.shtml. Providers may request paper copies of the tables by calling OMS at 1-866-690-5585. TTY 711.
*Maximum allowance Effective 7/1/18
THE DEPARTMENT EXPRESSLY DISCLAIMS THE ACCURACY OF THE CALCULATIONS TABULATED IN TABLES 1 & 2 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 or IIB.
Appendix IIA is for members Authorized with Regular service. Appendix IIB is for members authorized with Medical Add On services.
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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 |
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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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MaineCare Member |
Actual Regular Support Hours up to 168 |
Hours in excess of 168 |
Actual Medical Support Hours |
Actual Total Support Hours (sum total of all types of support hours) |
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A |
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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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Actual support hours provided in a week by Type |
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Range of total Authorized support Hours |
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Hours Authorized |
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Lowest - 92.5% total weekly of Authorized Hours |
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Highest - 105% total weekly of Authorized Hours |
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If Actual weekly hours provided fails within or above the range or authorized total weekly support hours than the provider should bill at the authorized member Per Diem (daily) rate from above. If Actual weekly hours provided falls below the range of authorized total weekly support hours then the provider should bill actual number of hours provided times the reimbursement rate. See Calculator below |
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Regular Support Hours up to 168 |
Hours in excess of 168 |
Medical Support Hours |
Total Actual Support Hours (sum total of all types of support hours) |
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Actual support hours provided in a week by type |
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Hourly Support reimbursement rates by type |
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Total Weekly reimbursement amount for facility by type |
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Number of days per week |
7 |
7 |
7 |
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Number of members in facility that were authorized and provided service by type |
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Total Billable Per Diem(Daily) rate Amount |
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(Total amount / Days) / # of Consumers |
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