COVID-19 Long Term Care Supplemental Payment Information for Section 2, 67, and 97 Appendix C Providers 

COVID-19 Long Term Care Supplemental Payment Information for Section 2, 67, and 97 Appendix C Providers 

As previously communicated, pursuant to PL 2022, ch. 635, Sec. A-17, An Act To Make Supplemental Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and To Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2022, and June 30, 2023, the Department of Health and Human Services will be issuing $25 million in state and federal 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).  

Facilities that were operational and serving clients as of June 1, 2022, will receive this COVID-19 supplemental payment. The Department will issue payments to all facilities in single lump sum amounts on August 3, 2022. The date of receipt depends on individual provider’s payment format and bank arrangements. The payments will be included as part of this week’s payment cycle and will be indicated as an “OTHER” payment on the Summary page of the paper remittance advice (RA) and as an invoice number beginning with “LTC” on the 835. 

METHODOLOGY 

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 $25 million, RCFs approximately 23%, and AFCHs approximately 2%. 

Summary of Methodology. Within the allocations for each facility type, 75% will be distributed proportional to each facility’s CY2019 MaineCare revenue for these services, while the other 25% will be allocated proportional to the facility’s total MaineCare bed days for service dates in CY2021. For facilities of any type that received little to no MaineCare revenue in CY2019, the Department will use revenue from an alternate, more recent 12-month period to determine distribution of the supplemental payment amounts by facility. For changes in ownership during this time period, the Department will use CY2019 MaineCare revenue for the facility under its previous ownership status. 

Detail of Methodology. First, the overall payment was allocated to each Provider Type (Nursing Facilities, Residential Care Homes and Adult Family Care Homes) based on revenue paid to each Provider Type.   

Then, 75% of the respective totals for the provider types was allocated to the revenue-based portion of the payment and the remaining 25% was allocated to the MaineCare bed day-based portion.   

The revenue portion was then allocated to individual facilities based on their relative shares of total revenue for each provider type. The MaineCare bed day portion was allocated to providers based on their respective shares of MaineCare bed days between January and December of 2021.   

The revenue-based and MaineCare bed days-based components were then added up for each site, and payments to the pay-to provider were summed, as applicable, across sites, regardless of provider type. 

Multi-level facilities should contact Bruce Cosgrove to determine their total payment amount per facility type. 

Facilities without a full year of CY2019 MaineCare reimbursement data. The Department made the determination on the basis of each individual facility that did not have a full year of CY2019 claims experience to determine which subsequent calendar or fiscal year period to use as the base year for the revenue portion of the payments. The Department reviewed the following time periods to select the period for each facility for which there were a full 12 months of claims available, and/or that reflected the highest revenue amount for the facility:  

• CY2020 (1/1/2020 – 12/31/2020) 
• SFY2021 (7/1/2020 – 6/30/2021) 
• CY2021 (1/1/2021 – 12/31/2021) 

AUDIT 

Use of Funds. These supplemental payments must be used to offset costs related to the COVID-19 pandemic, including costs directly related to COVID-19 (e.g., testing and personal protective equipment (PPE)), and costs indirectly stemming from the pandemic (e.g., costs related to the workforce shortage and higher energy and food costs). A cost not explicitly listed in this guidance may also be eligible, so long as the organization documents how the cost has been affected by the pandemic.  

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.   

The eligibility period for use of these funds is SFY 2023 (July 1, 2022, to June 30, 2023). Expenses already paid for by other funding cannot be claimed against these funds.  

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 related to the COVID-19 pandemic 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 pandemic-related expenditures and funding sources, including all federal sources, and maintain complete supporting documentation for these funds. 

QUESTIONS 

For questions regarding these payments and allowable uses of funds, please see the Frequently Asked Questions (FAQ) document, updated for August 2022. For any additional questions, please contact your Provider Relations specialist. Adult Family Care Home providers should contact Tammy Usher, and Residential Care Facility and Nursing Facility providers should contact Bruce Cosgrove. 

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.