C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-67, subsec. 144-101-II-67.06

Current through 2024-51, December 18, 2024
Subsection 144-101-II-67.06 - REIMBURSEMENT
A. Nursing facilities are reimbursed in accordance with this Section, Chapter III, Principles of Reimbursement for Nursing Facilities.
1. Except for nursing facilities which provide acquired brain injury services, reimbursement for ancillary services, including those provided by a NF that is a distinct part of a larger institution, such as medical supplies, physical therapy, occupational therapy, speech and hearing services, respiratory therapy, and pharmacy services is based upon reasonable cost or the maximum allowance.
2. Acquired Brain Injury (ABI) services shall be reimbursed pursuant to the "Intensive Rehabilitation NF Services for Brain Injured Individuals" section of the Principles of Reimbursement only when:
a) the member is classified, by the Department or its Authorized Entity, NF-ABI level pursuant to Section 67.02-5 and all relevant requirements;
b) the services were provided during an approved NF-ABI classification period; and
c) the ABI services were delivered in a CARF accredited facility (unless waived by the Department for an authorized out-of-state placement), and pursuant to Section 67.05-1 3(H).
3. Nursing facilities will be reimbursed under Chapter 115, Principles of Reimbursement for Residential Care Facilities, for those members qualifying for continued NF stay under Section 67.02-9.
B. In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek from any other sources payment for the rendered service prior to billing the MaineCare Program.
C. Nursing Facilities may not accept or receive payment for covered services in addition to the MaineCare payment.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-67, subsec. 144-101-II-67.06