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-45 - HOSPITAL SERVICES
- Subsection 144-101-III-45.01 - DEFINITIONS
- Subsection 144-101-III-45.02 - GENERAL PROVISIONS
- Subsection 144-101-III-45.03 - ACUTE CARE NON-CRITICAL ACCESS HOSPITALS
- Subsection 144-101-III-45.04 - ACUTE CARE CRITICAL ACCESS HOSPITALS
- Subsection 144-101-III-45.05 - HOSPITALS RECLASSIFIED TO A WAGE AREA OUTSIDE MAINE BY THE MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD (MGCRB) PRIOR TO OCTOBER 1, 2008
- Subsection 144-101-III-45.06 - REHABILITATION HOSPITALS
- Subsection 144-101-III-45.07 - VALUE-BASED PURCHASING (VBP) SUPPLEMENTAL SUB-POOL
- Subsection 144-101-III-45.08 - SUPPLEMENTAL POOL FOR NON-CRITICAL ACCESS HOSPITALS AND REHABILITATION HOSPITALS
- Subsection 144-101-III-45.09 - SUPPLEMENTAL PAYMENTS FOR ACUTE CARE HOSPITALS CONVERTING FROM ACUTE CARE CRITICAL ACCESS HOSPITAL REIMBURSEMENT TO ACUTE CARE NON-CRITICAL ACCESS HOSPITAL REIMBURSEMENT
- Subsection 144-101-III-45.10 - PRIVATE PSYCHIATRIC HOSPITALS
- Subsection 144-101-III-45.11 - STATE OWNED PSYCHIATRIC HOSPITALS
- Subsection 144-101-III-45.12 - OUT-OF-STATE HOSPITALS
- Subsection 144-101-III-45.13 - CLINICAL LABORATORY AND IMAGING SERVICES
- Subsection 144-101-III-45.14 - PROVIDER PREVENTABLE CONDITIONS
- Subsection 144-101-III-45.15 - DISPROPORTIONATE SHARE (DSH) PAYMENTS
- Appendix 144-101-III-45-A - DRG-BASED PAYMENT METHODOLOGY
- Appendix 144-101-III-45-B - NON-EMERGENT USE OF THE EMERGENCY DEPARTMENT
Current through 2024-38, September 18, 2024
INTRODUCTION
REIMBURSEMENT FOR SERVICES PROVIDED FROM JULY 1, 2024 THROUGH AUGUST 8, 2024, COMPLIES WITH 22 M.R.S. SEC.42(8).
MaineCare recognizes seven different types of hospitals for the purpose of reimbursement, all of which are detailed below. MaineCare uses a different payment methodology for each type of facility. MaineCare reimburses hospitals in the following ways:
1) *Acute Care Non-Critical Access Hospitals will be reimbursed using a Diagnosis Related Group (DRG) based methodology for inpatient services effective July 1, 2012, using Ambulatory Patient Classification system payments for outpatient services. There are three subsets of Acute Care Non-Critical Access Hospitals: rural hospitals, non-rural hospitals, and Acute Care Hospitals converting from Acute Care Critical Access Hospital reimbursement to Acute Care Non-Critical Access Hospital reimbursement;
2) *Non State Government Owned Hospitals will be reimbursed as Acute Care Non-Critical Access Hospitals, using a Diagnosis Related Group (DRG) based methodology for inpatient services and the Ambulatory Patient Classification system payments for outpatient services;
3) Acute Care Critical Access Hospitals will be reimbursed at a percentage of cost basis for inpatient and outpatient services;
4) State Owned Psychiatric Hospitals will be reimbursed on a cost basis for inpatient and outpatient services;
5) Private Psychiatric Hospitals will be reimbursed at a percentage of charge basis for inpatient services and at a percentage of cost basis for outpatient services; and
6) *Rehabilitation Hospitals will be reimbursed using Diagnosis Related Group (DRG) based methodology for inpatient services and Ambulatory Patient Classification system payments for outpatient services effective July 1, 2024.
* The Department shall submit to CMS and anticipates approval for a State Plan Amendment related to these provisions.
STATUTORY AUTHORITY: 22 M.R.S. §§42(8), 3173; 22 M.R.S. 3173-J; P.L. 2021, ch 635; P.L. 2023, ch 3, Sec. S-1.
