Attention: Nursing Facilities, Residential Care Facilities, Private Non-Medical Institutions (PNMI), and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) - Guidance on MaineCare cost report treatment of COVID-19 federal funding, including Provider Relief Funds and Paycheck Protection Program funds

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Attention: Nursing Facilities, Residential Care Facilities, Private Non-Medical Institutions (PNMI), and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) - Guidance on MaineCare cost report treatment of COVID-19 federal funding, including Provider Relief Funds and Paycheck Protection Program funds

Many providers have received federal funding support to help minimize the financial and operational impact of the COVID-19 pandemic. 

As we work with our federal partners to gain clarity on the treatment of  these funds on the MaineCare cost report for cost settlement purposes, we are providing the following guidance.

Until further notice, MaineCare providers of cost-settled programs, including Nursing Facilities and PNMI Appendices C, E and F, are required to report all federal funds associated with the COVID-19 pandemic received with the cost report on a separate schedule, available from the DHHS Division of Audit, that identifies the source of the funds, amount of funds received, and the use of the funds. Providers should NOT offset any of these funds on the cost report at this time.

If we receive further guidance from our federal funding partners on how the funds should be applied, we will adjust the audit accordingly, if needed, and will provide additional information at that time.

For more information on these programs, please visit the Provider Relief Fund and Paycheck Protection Program websites.

If you have any questions please contact Trisha White or Herb Downs. You may also call 207-287-2403.

 

Attention: Providers of Sections 18, 19, 20, 21 and 29 - Appendix K to Maine’s Home- and Community-Based Waiver Programs Amended

Please see the following updates to Maine’s Appendix K provisions:

• Appendix K End Date Modified to Six Months Post Federal Public Health Emergency
• New Self-Directed Option Available Under Sections 18 and 20
• Clarification about Role of Advanced Practice Providers Under Section 19
• Temporary Community Support Policy Adopted to Promote Telehealth
• Service Caps and Related Provisions Extended and Modified Through June 30, 2021

Appendix K to Maine’s Home and Community-Based Services 1915(c) waiver programs provides flexibility to operate waiver programs during an emergency. This flexibility was granted by the Centers for Medicare and Medicaid Services (CMS) in May 2020 in response to the COVID-19 public health emergency. CMS recently approved amendments to Appendix K that expand and extend temporary program flexibilities. Maine’s Appendix K and amendments may be found here. 

 

Appendix K End Date Extended

CMS has revised its policy to allow the continuation of Appendix K provisions for up to six months beyond the end of the federal Public Health Emergency. This new end date has been approved for Maine’s Appendix K. The federal Public Health Emergency is currently authorized through April 20, 2021, which means Maine’s Appendix K is currently authorized through October 20, 2021.  Based on recent information provided by the Biden Administration, it is likely that this date will be extended further. The Department will continue monitoring COVID-19 conditions and federal response and will further modify these flexibilities and expectations if needed.

 

New Self-Directed Option in Sections 18 and 20

Participants of Section 18 (Brain Injury) and Section 20 (Other Related Conditions) now have the option of directly hiring attendants to support them. Attendant Services, Financial Management Services, and Skills Training have been added for this self-directed option. Family members may become paid caregivers under this option with certain restrictions. Participants interested in pursuing this option or learning more should contact their care coordinators. 

 

Role of Advanced Practice Providers (APPs) in Section 19

Appendix K now clarifies that APPs are qualified to order and recertify a Plan of Care for Home Health Services in Section 19 (Older Adults and Adults with Physical Disabilities). This ensures consistency with MaineCare policy for home health offered under State Plan options.

 

Community Supports in Sections 20, 21 and 29

In order to promote telehealth alternatives during the pandemic, the member-to-staff ratio for community supports is temporarily expanded to allow up to a 6:1 member-to-staff ratio (up from the regular 3:1), while delivering these services via telehealth, contingent on the provider’s ability to ensure participants’ health and safety.

 

Service Caps and Other Provisions Extended and Modified Through June 30, 2021

Section K-2.b.ii. of Maine’s Appendix K was originally set to expire on May 31, 2020, but due to continuing need, the Department has extended this provision three times, most recently through February 28, 2021. At this time, given continuing challenges stemming from persistent community transmission of COVID-19 throughout Maine, and CMS’ recent flexibility for states to extend the end date of Appendix K, the Department will continue to provide flexibility under the Appendix K through June 30, 2021 with certain modified provisions to Section K-2.b.ii. 

Extended provisions include, but are not limited to the following flexibilities:    

• Budget allocations may be exceeded to address emergency needs;  
• Certain service caps may be exceeded to address emergency needs;
• Data transmission charges may be allowed up to $200 per person per month to accommodate greater access to telehealth services; and
• Per Diem staffing levels may be lower than 92.5% of authorized levels. This provision is being modified from previous flexibility provided to lengthen the gradual return to regular policy.

Provisions vary by waiver. Please read the additional information below for details.   

 

Appendix K, Section K-2.b.ii Provisions Extended Through June 30, 2021 

Appendix C-4:   

The budget allocations enumerated in Appendix C-4 of the Home and Community-Based Services for Members with Brain Injury (ME.1082), the Elderly and for Adults with Disabilities (ME.0276), the Home and Community Based Services for Adults with Other Related Conditions (ME. 0995), the Home and Community Based Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (ME 0159), and the Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (ME.0467) waivers may be temporarily exceeded to provide needed services for emergency care.    

 

Service Limits in Sections C-1/C-3   

ME.0276 (Section 19)   

• Increase the limit of available hours within Personal Care Services by up to 20 percent per week.   
• Increase the limit for the provision of care coordination by up to 20 percent per month   
• Increase the limit on Assistive Technology Device and Services to $6,000 and $200 per month for Assistive Technology- Transmission with prior authorization, and remove these services from the monthly program cap.   
• Increase the limit on Respite Services by up to 20 percent per week.   
• Increase the limit on Home Delivered Meals from one meal/day to two meals/day and remove the total cost from the monthly cap of combined Personal Care, Attendant Care, Respite, Assistive Technology and Living Well/Matter of Balance services.   
• Remove budget allocation limits and individual caps on service to accommodate these temporary service increases.    

ME.1082 (Section 18), ME.0995 (Section 20), ME.0159 (Section 21), and ME.0467 (Section 29)    

• Increase the service limits to Quarter Hour Home Supports to up to 64 units per day.   
• Increase the limit on Assistive Technology Transmission to $200 per month for data transmission with prior authorization and remove Assistive Technology Transmission from the overall cap for ME.1082 and ME.0995.   
• Modify limitations on Respite Services for ME.0467.   
• Modify limits on Care Coordination units for ME.1082 and ME.0995.   
• The provision allowing per diem staffing levels to fall below authorized levels, provided that agencies can ensure members’ health and safety, is modified as follows:
  • January 1, 2021 to June 30, 2021: Staffing levels may be no lower than 70% of authorized levels.

At this time, the Department’s expectation is that members’ service plans will resume within regular policy service limits, and provider staffing levels will return to at least 92.5% of authorized levels, by July 1, 2021.