10-144-101 Me. Code R. § III-45

Current through 2024-44, October 30, 2024

Section 144-101-III-45 - HOSPITAL SERVICES

INTRODUCTION

REIMBURSEMENT FOR SERVICES PROVIDED FROM JULY 1, 2024 THROUGH AUGUST 8, 2024, COMPLIES WITH 22 M.R.S. SEC.42(8).

MaineCare recognizes seven different types of hospitals for the purpose of reimbursement, all of which are detailed below. MaineCare uses a different payment methodology for each type of facility. MaineCare reimburses hospitals in the following ways:

1) *Acute Care Non-Critical Access Hospitals will be reimbursed using a Diagnosis Related Group (DRG) based methodology for inpatient services effective July 1, 2012, using Ambulatory Patient Classification system payments for outpatient services. There are three subsets of Acute Care Non-Critical Access Hospitals: rural hospitals, non-rural hospitals, and Acute Care Hospitals converting from Acute Care Critical Access Hospital reimbursement to Acute Care Non-Critical Access Hospital reimbursement;

2) *Non State Government Owned Hospitals will be reimbursed as Acute Care Non-Critical Access Hospitals, using a Diagnosis Related Group (DRG) based methodology for inpatient services and the Ambulatory Patient Classification system payments for outpatient services;

3)Acute Care Critical Access Hospitals will be reimbursed at a percentage of cost basis for inpatient and outpatient services;

4)State Owned Psychiatric Hospitals will be reimbursed on a cost basis for inpatient and outpatient services;

5)Private Psychiatric Hospitals will be reimbursed at a percentage of charge basis for inpatient services and at a percentage of cost basis for outpatient services; and

6) *Rehabilitation Hospitals will be reimbursed using Diagnosis Related Group (DRG) based methodology for inpatient services and Ambulatory Patient Classification system payments for outpatient services effective July 1, 2024.

* The Department shall submit to CMS and anticipates approval for a State Plan Amendment related to these provisions.

10-144 C.M.R. ch. 101, § III-45

EFFECTIVE DATE
December 18, 2023 - filing 2023-251
8/9/2024 - filing 2024-179

STATUTORY AUTHORITY: 22 M.R.S. §§42(8), 3173; 22 M.R.S. 3173-J; P.L. 2021, ch 635; P.L. 2023, ch 3, Sec. S-1.