22 M.R.S. §1708-A: Reimbursement to Maine Veterans' Homes

Nursing facility services provided by a veterans' facility must be reimbursed by the MaineCare program at rates established by the department pursuant to this section. This section applies to all funds, including federal funds, paid by an agency of the State to a veterans' facility for nursing facility care.

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A. "Nursing home" or "nursing facility" has the same meaning as in section 1812‑A.

B. "Residential care facility" has the same meaning as in section 7852, subsection 14.

C. "Veterans' facility" means a nursing home that is operated by the Maine Veterans' Homes at any location required under Title 37‑B, section 601, subsection 2.

2. Per resident basis. Veterans' facilities must be reimbursed on a per resident daily rate basis for services to residents covered under the MaineCare program.

3. Rate calculations. Rate calculations under this section must follow the process and principles set forth in section 3173‑J to determine a daily rate that is reasonable and adequate to cover the MaineCare allowable costs of operating veterans' facilities and to reflect any meaningful cost differences between veterans' nursing home and nonveterans' nursing home costs for the direct care and routine care cost components of the daily rate. Adjustments to rates and reimbursement for purposes that include, but are not limited to, audit procedures, quality and case mix must be made in the same way as those adjustments are made for all other nursing facilities as set forth in department rule.

4. Annual adjustments for inflation. The daily rate amounts calculated under this section must be annually adjusted for inflation to the same extent that MaineCare reimbursement rates for nonveterans' facilities that are nursing homes and residential care facilities are adjusted.