[Provider] Facts about Leave Days

[Provider Notification]

ATTENTION:  MaineCare Providers tracking leave days as a part of member
services


Facts about leave days for: 


*    Medical and Remedial Service Facilities (Appendix C) and 


*    Non-case mixed Medical and Remedial Facilities (Appendix F) 


 

*	Each member is entitled to 30 days per year for the room and
board state funded service only. There are no leave days for the
clinical/treatment portion of the service. 

 

*	The facility is responsible to accurately track the number of
leave days used by each resident 

 

*	If the 30-day leave limit has expired, discharge is not
mandatory by MaineCare 

 

*	MaineCare cannot require a facility to hold a bed when a
member's leave days have expired. The provider must make sure they
follow Licensing guidelines for discharge. 

 

*	The Provider must decide if they will hold the bed without
payment 

 

*	If the Provider decides to hold the bed without payment and not
discharge, no paperwork is sent to Office of Elder Services (OES) 

 

*	If the provider decides to discharge the member and not hold the
bed, then the provider must send discharge paperwork to OES 

 

*	If the provider discharged a member, the bill to MaineCare
should show a discharge date 

 

*	When the provider bills for month of admission, the claim should
show the admission date 

 

*	Follow the normal rules for cost of care decisions based on the
living situation of the member prior to their admission.  Whether a cost
of care is collected, or not, depends on where the member resided during
the month.    

 

*	When a member's leave days are exhausted, then there would be no
payment made by MaineCare for any additional leave days. 

 


Facts about leave days for all other PNMI Facilities: 


*                            Substance Abuse Treatment Facilities
(Appendix B), 


*                            Child Care Facilities (Appendix D), And 


*                            Community Residences for Persons with
Mental Illness (Appendix E) 


 

*	Bed hold days are not reimbursable. 

 

PNMI transfer and discharge forms
<https://portalxw.bisoex.state.me.us/transfers/pnmi/>  are available
online.  If you have questions about billing, feel free to contact
MaineCare Billing & Information at 1-800-321-5557 Option #8.  

 

 

Is your mailing address up to date with MaineCare?  Please keep
MaineCare up to date so your Remittance Statements and checks arrive on
time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

If you would rather not get these e-mails, visit MaineCare's List Serve
Subscription
<http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml>  page
to unsubscribe.

 

This is a one-way communication.  Do not reply to this e-mail.  Your
e-mail will not receive response.  If you have questions, please call
1-800-321-5557.  

 

 

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