[Provider] Hospital Reimbursement Update from MaineCare

[Provider Notification]

ATTENTION:  MaineCare Hospital Providers

 

This is information related to a recently adopted rule.

 

CHAPTER NUMBER AND TITLE:  MaineCare Benefits Manual, Chapter III,
Section 45, Hospital Services

 

CONCISE SUMMARY:        The Department is adopting rules for hospital
reimbursement that have an effective date of August 1, 2006.  This rule
change increases total state and federal expenditures for hospital
services by approximately $4.9 million for SFY '07. 

 

The changes adopted in this rulemaking include the following areas:

 

*         Acute care, non-critical access hospitals: The Department is
reformulating its price per discharge calculation and the associated
Prospective Interim Payment (PIP) amounts. Per discharge payments for
acute care and distinct psychiatric units are reduced. In addition, a
total pool of approximately $35 million will be distributed among these
hospitals based on relative share of inpatient discharges. Additionally,
the PIP will be capped at the greater of the PIP that a hospital
received during SFY '06 or 72% of the PIP calculated for SFY '07. 

 

*         Critical access hospitals: One million dollars will be added
to the supplemental pool available for distribution. 

 

*         Hospitals that have been reclassified to a wage area outside
Maine by the Medicare Geographic Classification Review Board: This new
category of hospitals will be created for reimbursement purposes.
Reimbursement will be 117% of costs.

 

The Department also clarified terminology in the rule and added more
specificity to data used to calculate the PIP. 

 

EFFECTIVE DATE:

August 1, 2007 

 

AGENCY CONTACT PERSON:

Patricia Dushuttle

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

 

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