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-E - COMMUNITY RESIDENCES FOR PERSONS WITH MENTAL ILLNESS
Section 144-101-III-97-E-3400 - SETTLEMENT OF COST REPORTS
Universal Citation: 10 ME Code Rules ยง 144-101-III-97-E-3400
Current through 2024-38, September 18, 2024
3400.1 Uniform Desk Review
3400.1.1 The Division of Audit shall
perform a uniform desk review of each acceptable cost report
submitted.
3400.1.2 The uniform desk
review is an analysis of the provider's cost report to determine the adequacy
and completeness of the report, accuracy and reasonableness of the data
recorded thereon, and allowable costs.
3400.1.3 Based on the results of the uniform
desk review, the Division of Audit shall:
1.
Request more information
2. Issue a
final settlement, or
3. Conduct a
field audit and issue a final settlement.
3400.2 Calculation of Final Settlement
3400.2.1 The total actual costs of the
facility shall be determined in accordance with Section
2400 in Chapter III and
this Appendix.
3400.2.2 The total
cost cap approved in the facility budget shall be determined in accordance with
Section
6000 of this
Appendix.
3400.2.3 The allowable
cost shall be limited to the lesser of the total actual cost of the facility,
which includes the State-mandated service tax, or the sum of the total cost cap
approved in the facility budget plus the State-mandated service tax and program
allowance on the service tax.
3400.2.4 To determine the allowable cost per
bed day, the allowable cost shall be divided by the total actual days of
care.
3400.2.5 The allowable cost
per bed day shall be multiplied by MaineCare eligible days to determine the
reimbursable MaineCare cost.
3400.2.6 Final settlement: The reimbursable
MaineCare cost, determined through the audit, shall be compared to the interim
payments to determine an overpayment or underpayment.
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