PNMI Temporary Rate Increases

Attention PNMI Providers

 

As announced earlier today, effective March 1, 2020 through May 31, 2020, DHHS is temporarily increasing payments to a range of congregate care facilities to support their preparedness and response to the COVID-19 pandemic. 

 

This temporary rate increase is intended to help ensure that providers are reimbursed for their proactive response to the pandemic and to address cost increases related to COVID-19, with an emphasis on ensuring adequate direct care staffing and high-quality care for residents. 

Private Non-Medical Institutions (PNMIs) serving children, older Mainers, and people with substance use and mental health disorders will receive temporary rate increases. These include:

• Appendix B, Substance Use Treatment Facilities
• Appendix C, Residential Care (Medical and Remedial Service Facilities)
• Appendix D, Child Care Facilities (Room & Board rate)
• Appendix E, Community Residences for Persons with Mental Illness
• Appendix F, Non-Case Mixed Medical & Remedial Facilities

Appendix D, E, and F providers will receive individual rate letters from the Department today, April 17^th, outlining the specific payment support details for each facility and may begin billing at the increased rate immediately. Providers who have already submitted claims for services provided on or after March 1, 2020 will need to adjust those claims to receive the increased rate.

Appendix C providers will receive their rate letters on Tuesday, April 21^st, and will be able to bill at the increased rate at that time. Appendix C providers who have already submitted claims for services provided on or after March 1, 2020 will need to adjust their claims to receive the increased rate. We are encouraging Appendix C providers to hold claims that they have not yet submitted until April 21^st when they receive their rate letters and are able to bill under their increased rates.

Appendix B providers can find the information about their rate increases in the table below.

 

PNMI Appendix B Temporary Rate Increase

Effective March 1, 2020 – May 31, 2020 for in-state providers only

Code	Description	Temporary Increased Rate
H2034	Halfway House Services, Per Diem	$131.45
H2036	Extended Care, Per Diem	$144.83
H2036	HF Residential Rehabilitation Type I, Per Diem	$278.09
H2036	HA Adolescent Residential Rehabilitation, Per Diem	$232.53
H2034	HF Residential Rehabilitation Type II, Per Diem	$148.25
H0010	Detoxification, Per Diem	$269.47

 

Please note: The new Appendix B rates will be available in MIHMS on April 22^nd. Appendix B providers who have already submitted claims for services provided on or after March 1, 2020 will need to adjust their claims to receive the increased rate. We are encouraging providers to hold claims that have not yet been submitted until April 22^nd when the increased rates are available in the system.  

In addition to these rate increases for PNMIs, on March 26^th, DHHS announced its plans for supporting Nursing Facilities and Intermediate Care Facilities, also effective March 1^st.  These providers will receive their rate letters today, April 17^th, and may begin billing at the increased rate immediately. Providers who have already submitted claims for services provided on or after March 1, 2020 will need to adjust those claims to receive the increased rate.

For additional information on how the Department is working to support Maine citizens and health care providers during this public health emergency, please visit its COVID-19 webpage. If you have questions, please contact MaineCare Provider Relations Specialist, Tammy Usher.