Supplemental Payment Information for Sections 2, 67, and 97 Appendix C Providers

Supplemental Payment Information for Sections 2, 67, and 97 Appendix C Providers

 

Pursuant to PL 2021 Chap 398 (pages 107, 118, 131, and Sec QQQQ-1), the Department of Health and Human Services will be issuing over $37 million in state funds in supplemental COVID-19 payments to in-state Nursing Facilities (NFs), PNMI Appendix Cs (Residential Care Facilities, or RCFs), and Adult Family Care Homes (AFCHs). The Department estimates that this will draw approximately $86 million in federal matching funds, for a total of just over $123 million.

These funds will be distributed proportionally based on each facility type’s Calendar Year (CY) 2019 MaineCare revenue for these services. This will result in NFs receiving approximately 75% of the $123 million, RCFs approximately 23%, and AFCHs approximately 2%. 

Within the NF and RCF allocations, 75% will be distributed proportionally based on each facility’s CY19 MaineCare revenue for these services, while the other 25% will be allocated to provide greater assistance to facilities with lower occupancy rates in the second half of State Fiscal Year 2021. The AFCH allocation will be distributed entirely based on each facility’s share of total CY19 AFHC MaineCare spending. For facilities of any type that received little to no MaineCare revenue in CY19, the Department will use revenue from an alternate, more recent 12-month period to determine distribution of the supplemental payment amounts by facility.

Facilities that were operational and serving clients as of September 1, 2021 will receive a supplemental payment. Payments to all facilities will be made in two lump sum amounts with the first payment issued in September and a second payment in October. The September payment will be approximately half of the total payment, and the October payment will make up the remaining balance.

State and Federal Authorities. Payments for NFs and RCFs will be made under existing Extraordinary Circumstance Allowance (ECA) allowance, per MaineCare Benefits Manual (MBM) Ch. III, Section 67, Principle 34 (Nursing Facilities) and MBM Ch. III, Section 97-C, 2400.7 (Medical and Remedial Service Facilities/PNMI-Cs), as both types of facilities have experienced, and will continue to experience, unforeseen and uncontrollable events due to the COVID-19 pandemic that result in uncontrollable increases in expenses, and that the costs incurred are reasonable and necessary. 

The Department will conduct rulemaking and seek CMS approval for the payments to AFCHs under MBM Ch. III, Section 2.

Use of Funds. These supplemental payments must be used to offset costs associated with the Public Health Emergency during the period of time from July 1, 2021 to June 30, 2022. Acceptable uses of these funds include to pay for increased costs related to ensuring recruitment and retention of direct care/front line staff to meet members’ needs. Other allowable costs could include payments to assist with retention of other essential personnel, non-communal dining, visitor/vendor screening, housekeeping and supplies, testing supplies and/or costs, and personal protective equipment (PPE) and other face coverings necessitated by COVID-19. Compensation to staff to aid in recruitment and retention may include overtime pay and bonuses for essential personnel. Essential personnel are defined as anyone regularly working at the facility, although these payments should be primarily targeted toward direct care workers and/or those who are required to be in the facility on a day-to-day basis. Any compensation to staff is required to be reasonable. Expenses already paid for by other funding cannot be claimed against these funds.

Bonus payments at Nursing Facilities. The MaineCare Benefits Manual, Chapter III, Section

67 requires that bonuses are provided under a written policy of the provider and are related to measurable and attainable job performance expectations. Therefore, if a provider plans to implement a recruitment and/or retention bonus, they need to create a brief written policy that outlines the rationale, performance basis, and amount of the bonus.  

Cost Settlement. NFs and PNMI Appendix C, only: The supplemental payment will be reconciled at the same time as the provider’s annual cost report audit. The reconciliation of the supplemental payment and the audit of the cost report will be done separately. Providers will need to submit a financial reconciliation to the DHHS-Division of Audit with their cost report filing.  The financial reconciliation must document the actual costs incurred for COVID-19 related expenditures compared to the supplemental payments received.  The Department will review the submissions for reasonableness and necessity of the expenditures and settle on any under/overpayment.  For cost report filings, any expenditures paid by the supplemental payment should be removed through a cost report adjustment.

To assist in the settlement of the supplemental payment, facilities should track their COVID-related expenditures and funding sources, including all federal sources, and maintain complete supporting documentation for these funds.

If you have any questions regarding cost settlement, please contact Trisha White with the Division of Audit at DHHS.Audit@maine.gov with “COVID-19 LTC Supplemental Payment Question” in the subject line or call the Division of Audit main line at 207-287-2403.

We will send another listserv when the first installment of payments is ready for issuance.