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-67 - Principles of Reimbursement for Nursing Facilities
Subsection 144-101-III-67-42 - VENTILATOR CARE SERVICES

1. The nursing facility must supply their own ventilators; and

2. The nursing facility must employ or contract with a pulmonologist or other health care professional trained in respiratory therapy; and

3. The nursing facility must have the required additional staffing to meet the needs of ventilator dependent members.

Principle. A nursing facility with qualifying ventilator care services under this section will be reimbursed for the additional care associated with members receiving ventilator care through a prior authorization from the Department using CPT code 94004. Prior authorization for these services will state what is included in the custom reimbursement rate.

Rate setting. Qualified providers must receive a prior authorization from the Department to bill for Ventilator Services.

Audit. The additional ventilator care add-on will be considered an ancillary service. All costs including general & administrative costs associated with the provision of ventilator care services will be considered ancillary costs and will not be cost settled. Any capital costs that are incurred as a result of the development of a vent unit or due to the admission of a vent patient will also be considered ancillary costs that are not reimbursable during cost settlement.