Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 115 - PRINCIPLES OF REIMBURSEMENT FOR RESIDENTIAL CARE FACILITIES - ROOM AND BOARD COSTS
Section 144-115-37 - DAYS WAITING PLACEMENT

37.1.1 The resident has received notice that they are not medically eligible for MaineCare benefits, the facility has initiated the discharge process, and it has been determined that there is no safe and appropriate placement currently available.

37.1.2 The individual meets the financial eligibility requirements for MaineCare coverage in a cost reimbursed residential care facility, as determined by the regional Office for Family Independence.

37.1.3 The member met the MaineCare medical eligibility criteria in effect at the time of admission to the nursing facility. The nursing facility shall conduct an assessment using the Department's approved medical eligibility determination assessment form (MED) to document the member's medical eligibility. Only if the member was admitted prior to the MED assessment, a completed MDS may be substituted for the MED.

37.1.4 The nursing facility accepts as payment in full the rate of reimbursement for days awaiting placement and does not receive any additional payment from a third party to supplement this rate.

37.1.5 The nursing facility continually pursues discharge of the member. The nursing facility shall continue to document in the member's record all efforts to locate appropriate placement.

37.1.6 The member accepts the first available, appropriate placement within a thirty (30) mile radius of his/her residence (Chapter II, Section 67, Nursing Facilities, Definitions of the MBM). The member may accept a placement beyond the thirty (30) mile radius. However, this is not required. The nursing facility must notify the Department if a member refuses a placement meeting these criteria. If the member refuses this placement, the Department will issue a thirty (30) day notice to the nursing facility that reimbursement will terminate.

37.1.7 The Department will reimburse the difference between the eligible member's assessment (cost of care) and the rate determined by the Department. This rate shall be published on July 1st of each year and shall be equal to the sum of the Statewide average cost reimbursed residential room and board rate less fixed costs and the administrative allowance, and the average MaineCare rates. It is the responsibility of the nursing facility to assist the member in applying for any benefits that the resident may be eligible for, such as federal Supplemental Security Income, that might be applied toward the member's cost of care. Payments will not be considered in the reconciliation of the nursing facility's cost report. This includes removal of the days of care from the nursing home census in such reconciliation.