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-97 - Private Non-Medical Institution Services
Appendix 144-101-III-97-B - SUBSTANCE USE TREATMENT FACILITIES
Section 144-101-III-97-B-6000 - RATE SETTING
Current through 2024-38, September 18, 2024
6000.1 The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for this Section. Pending approval, the following reimbursement rates will be effective retroactive to July 1, 2016* and August 1, 2018*** as indicated below:
The following capitated rates apply to Appendix B services.
|
SERVICE DESCRIPTION |
AMOUNT Effective 7/1/19 |
AMOUNT Effective 11/1/21* |
UNIT |
|
Medically Supervised Withdrawal Services (Non Hospital based) |
$217.48 |
$385.55 |
per diem |
|
Medically Supervised Withdrawal Services (Non Hospital based - exception rate for low RN |
$238.12 |
per diem |
|
|
Halfway House services |
$106.09 |
$165.67 |
per diem |
|
Extended Care |
$116.89 |
$137.21 |
per diem |
|
Residential Rehabilitation Type I |
$224.44 |
$287.91 |
per diem |
|
Residential Rehabilitation Type II |
$119.65 |
$165.67 |
per diem |
|
Adolescent Residential Rehabilitation |
$187.67 |
$254.78 |
per diem |
|
Personal Care Substance Use (Substance Use Shelter Services) |
$56.87 |
$56.87 |
per diem |
The Department shall seek approval from CMS for this Section (for the rates * above).
Members are assessed as described in Chapter II, Section 97, and assigned to one of the types of substance use treatment services described above. Providers bill the Department on a per diem basis for each member receiving service. The capitated rate includes all PNMI services required by the member for his or her type of service including all staffing required pursuant to State of Maine licensing guidelines and as identified in the members individual service plan. There is no cost settlement for Appendix B PNMI services.
6000.2 The provider must submit, upon request, such data, statistics, schedules, or other information required by the OMS and OBH.
6000.3 The standardized rate for each Substance use treatment service type will begin November 15, 2010.
6000.4 Providers must ensure that the increase in reimbursement rates effective August 1, 2018 is applied in full to wages and benefits for employees who provide direct services. Providers must document compliance with this requirement in their financial records and provide such documentation upon request. The increase must be granted or paid out retroactively from the date the Department begins reimbursing the increased rates.
