C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-50, subsec. 144-101-III-50-7000
For the first rate set by these Principles, an adjustment to the prospective variable component will be made to transfer allowable FY 2004 central office fixed costs to variable costs.
When a central office bookkeeping system is set up, salary costs will be removed from retrospective reimbursement and will be transferred to the variable cost component.
Example: A new rate letter effective July 1, 2006 through fiscal year ended June 30, 2007 would be based on:
| Rate Components: | Rate source: last audited cost report or 06/30/04 | InflationfactorTo FY2005 | InflationfactorTo FY 2006 | InflationfactorTo FY2007 | 06/30/07 |
| Fixed rate - including fixed central office costs (source last audited cost report- say FY 2004) | $30.00 | ||||
| Less: fixed portion of central office costs FY 2004 Fixed rate net of fixed portion of central office costs FY 2004 | ($2.50) $27.50 | $27.50 | |||
| Prospective variable rate without fixed portion of central office costs (source FYE 06/30/04) | $50.00 | ||||
| Plus: fixed portion of central office costs FY 2004 Prospective variable rate with fixed portion of central | $2.50 | ||||
| office costs (source FYE 06/30/04) | $52.50 | 2 % | 2 % | 2 % | $55.71 |
| ($52.50 x 1.02 x 1.02 x 1.02 = $55.71) | |||||
| Labor rate(source last audited cost report-say FY 2004) | $200.00 | 3 % | 3 % | 3 % | $218.55 |
| ($200.00 x 1.03 x 1.03 x 1.03 = $218.55) | |||||
| $280.00 | $301.76 | ||||
The subsequent rate will be calculated as follows:
Example: A new rate letter effective July 1, 2007 through fiscal year ended June 30, 2008 would be based on:
| Rate components: | Rate source: lastaudited costreport or06/30/04 or FY07 rate letter | Inflation factor To FY 2008 06/30/08 |
| Fixed rate - including fixed central office costs (source last audited cost report- say FY 05) | $32.00 | |
| Less: fixed portion of central office costs FY 05 | ($3.00) | |
| Fixed rate net of fixed portion of central office costs FY 05 | $29.00 | $29.00 |
| Prospective variable rate with fixed portion of central office costs (source FYE 06/30/04 plus inflation to FY 07) | $54.62 | 2 % $55.71 |
| Labor rate(source last audited cost report-say FY 05 plus inflation through FY 07) | $210.00 | ($54.62 x 1.02 = $55.71) 3 % $216.30 |
| ( | $210.00 x 1.03 = $216.30) | |
| $293.62 | $301.01 |
A facility may request an adjustment to its interim prospective rate, not to exceed actual costs of employee wages, salaries, and benefits for a current twelve (12) month period. In order to receive an adjustment to the interim prospective rate a facility must submit documentation of actual cost adjusting for the changes described in these rules. At the time of audit, the Department will determine actual allowable costs and will determine the final settlement based on the actual allowable costs.
A facility may request an interim adjustment as described above only once, unless it can demonstrate extreme hardship. Such an adjustment based on extreme hardship will be granted no more often than once every six (6) months. Facilities must submit documentation to the Office of Audit when applying for an interim adjustment.
All facilities will be required to submit a cost report at the end of their fiscal year on cost report forms provided by the Department. The Department will conduct a final audit of each facility's cost report that may consist of a full scope examination by Department.
Upon final audit of a facility's cost report for the first and subsequent prospective years, the Department will:
ICFs-MR that operate in an efficient and economical manner, and thereby limit their variable costs during their fiscal year to less than the amounts paid through the variable cost component of the final prospective rate, will share with the Department in the resulting savings. Eligible ICFs-MR will receive an incentive payment after final audit in an amount equal to fifty percent (50 %) of the variable cost savings.
The amount of the incentive payment will be determined upon final audit and will be calculated in the determination of any overpayments or underpayments made by the Department.
ICFs-MR that incur variable costs during their fiscal year in excess of or equal to the variable cost component of the prospective rate will receive no more than the amount allowed by the prospective rate.
Example: Facility A's final prospective rate included a variable cost component of $34.56. During the year, it actually incurs an allowable variable cost per day of $34.00. Ninety percent (90%) of the 29,200 days of care provided (or 26,280 days of care) were provided to MaineCare members. The difference ($34.56 - $34.00 x 26,280 = $14,717) will be the savings that Facility A and the Department will share. Facility A will retain $7,358.50 (.50 x $14,717) and the Department will retain $7,358.50 (.50 x $14,717) in savings.
If the Department issues a conditional or temporary license or formally notifies an ICF-MR that it must immediately correct its deficiencies, the ICF-MR will be ineligible to receive an "incentive payment" for the fiscal year in which the deficiency notice, conditional or temporary license was issued, and for any fiscal year in which it has not cured the deficiency to the satisfaction of the Department.
Upon determination of final prospective rate, the Department will calculate the net amount of any overpayments or underpayments made to the facility.
If the Department determines that it has underpaid a facility, it will estimate the amount due and forward the result to the facility within thirty (30) days.
If the Department determines that it has overpaid a facility, the Department will notify the facility pursuant to Title 22, Section 1714-A(3). Facilities will pay the total overpayment within sixty (60) days of the notice of overpayment or request the Department to reduce future payments to the facility. Facilities that do not notify the Department of the method by which they intend to repay the overpayment will, beginning sixty (60) days after their receipt of the notice of overpayment, have their subsequent payments from the Department reduced by the amount of the overpayment, pursuant to state and federal rules and regulations.
If a facility appeals a determination of overpayment, the facility may voluntarily repay within sixty (60) days of the notice of overpayment all portions of the determined overpayment except those that are expressly disputed and for which specific dollar values are identified. Repayment of each such specifically disputed portion and identified amount shall be stayed pending resolution of the dispute with respect thereto. The amount of money in dispute must be identified in the manner outlined in Section 8010.
The cost per student cannot exceed the cost of tuition in a program offered through the Department of Education. If it is determined that any of the CNA training programs offered by a facility have not met or do not presently meet the requirements of the Maine Board of Nursing or are not an approved program through the Department of Education and the Department of Professional and Financial Regulation, the Department will initiate action to recoup all reimbursement.
All income received from these programs must be used to reduce the overall cost of the services.
Any request that is not received before the end of the facility's current fiscal year in which the CNA program begins will not be considered as an allowable cost under MaineCare.
All requests must include:
The Department will reimburse the facility its fair share of allowable CNA training program costs based upon the number of MaineCare residents at the facility. The allowable cost of approved CNA training programs at the facility will not be included in the calculation of the facility's prospective rate, but will be reimbursed in a lump sum payment upon approval by the Office of MaineCare Services.
At the start of participation in the program, available historical data relating to a provider's costs will be received by the State of Maine Department of Health and Human Services and an interim prospective payment rate will be established for such provider. This rate will be based on the rate approved by the Department in accordance with the provisions of the Maine Certificate of Need Act. The rate approved by the Department in accordance with the provisions of the Maine Certificate of Need Act for a facility's first year of operation will be adjusted at the time the facility opens to reflect actual inflation since the approval of the Certificate of Need. The facility's second year prospective rate will be based on the second year projected rate approved under the Maine Certificate of Need Act adjusted for actual inflation since the approval of the Certificate of Need The third fiscal period and subsequent periods will be based on the second fiscal period of operation. The second fiscal period of operation will be used as a "base year" going forward, unless the Department determines there is a need to rebase.
In the case of a sale of a facility, the Department will review the new owner's Certificate of Need application and evaluate the appropriateness and reasonableness of the capital related costs as well as operating costs. The Department will establish a prospective rate for the new owner of the facility based on its analysis under the Certificate of Need process.
Facilities that experience unforeseen and uncontrollable events during a year that result in unforeseen or uncontrollable increases in expenses, may request an adjustment to a prospective rate in the form of an extraordinary circumstance allowance. Extraordinary circumstances include, but are not limited to:
If the Department concludes that an extraordinary circumstance existed, an adjustment will be made by the Department in the form of a supplemental allowance.
The Department will determine from the nature of the extraordinary circumstance whether it would have a continuing impact and therefore whether the allowance should be included in the computation of the base rate for the succeeding year.
The Department will adjust any interim or final prospective rate to reflect appeal decisions made subsequent to the establishment of those rates.
C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-50, subsec. 144-101-III-50-7000