COVID-19 Outbreak Rate Guidance for Congregate Care Facilities
Maine Department of Health & Human Services sent this bulletin at 07/01/2020 08:23 AM EDT
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Guidelines on Payment Supports for Congregate Care Facility COVID-19 Outbreaks
To support Nursing Facilities (NFs), Intermediate Care Facilities (ICF-IDDs), and Appendices B, C, D, E, and F Private Non-Medical Institutions (PNMIs) that incur or have incurred additional expenses due to a COVID-19 outbreak within their facility, the Department is extending payment supports for facility outbreaks that were in progress as of June 1, 2020 or started on or after June 1, 2020. An outbreak is defined as three or more epidemiologically-linked, positive COVID-19 cases among members/patients or staff at the same facility, as identified by the Maine Center for Disease Control (CDC). The outbreak support ends for a facility once CDC has closed the outbreak, which happens once 28 days have passed with no additional confirmed cases.
The Office of MaineCare Services (OMS) is working with the CDC to identify facilities that have confirmed outbreaks of COVID-19, including the start and, where applicable, end dates of those outbreaks. Once OMS has identified these facilities, OMS Provider Relations will contact the facilities with instructions to bill for services at the enhanced outbreak rate. Facilities will then need to submit written confirmation of their desire to receive the enhanced outbreak rate over email to Provider Relations. If your facility has experienced an outbreak on or after June 1, 2020, we ask that you hold off on submitting claims for June services until after Wednesday, July 8, so that Provider Relations can assist you in the meantime to ensure that your claims for services during the outbreak period will pay at the enhanced outbreak rate without the need for retroactive claims adjustment.
At this time, the Department is offering these outbreak payment supports from June 1 through the end of the federal Public Health Emergency. The Department will reassess the need for, and Department capacity to provide, ongoing outbreak payment supports upon the end of the Public Health Emergency.
Guidelines for NFs, ICF-IIDs and Appendices C and F PNMI facilities:
NFs, ICF-IIDs and Appendices C and F PNMI facilities will receive this outbreak payment support under the authority of the Extraordinary Circumstance Allowance (ECA) under MaineCare rules.
NFs, ICF-IIDs and Appendices C and F PNMI facilities that experience an outbreak and confirm their desire to receive the enhanced rate will receive individual rate letters from the Department outlining the specific payment support details for each facility and may begin billing at the outbreak rate as instructed by Provider Relations at that time. Outbreak payment rates for these facilities will equal the ECA that expired on May 31, 2020.
The eligible time period for allowable costs under this outbreak support begins the first day of the outbreak or June 1, 2020, whichever is later.
Eligible costs include:
- Increased staffing expenses such as contracted staff, overtime pay, and hazard pay
- Additional dietary and CNA staff time for non-communal dining
- Additional attendant staff for staff and visitor/vendor screening
- Increased housekeeping staff
- Increased personal protective equipment (PPE)
- Additional supply costs for sanitizing the facility
Lost revenue is not an eligible expense; the support is only for incurred expenses.
The enhanced outbreak rate will be reconciled at the close of the facility’s outbreak status. Providers will need to submit a financial reconciliation to the DHHS Division of Audit no later than 30 days after the outbreak has closed. The financial reconciliation must document the actual costs incurred for COVID-19-related expenditures compared to the enhanced outbreak rate payments received. The Department will review the submissions for reasonableness and necessity of the expenditures and settle on any under/overpayment within 45 days.
Facilities will need to remove expenses allowed under the outbreak support when filing their annual cost report that includes the period during which the Department paid the higher outbreak rate.
Guidelines for Appendices B, D, and E PNMI facilities:
Outbreak payment rates for Appendix B PNMIs will be equivalent to the Temporary Rate Increases that expired on May 31, 2020. Appendix B providers should refer to the April 17, 2020 e-message regarding the Temporary Rate Increases for those rate amounts. Outbreak payment rates for Appendix D PNMIs will be set at 17.2% of the regular rates.
Outbreak payment rates for Appendices E PNMIs will equal the Temporary Rate Increase that expired on May 31, 2020. Appendix E facilities that experience an outbreak and confirm their desire to receive the enhanced rate will receive individual rate letters from the Department outlining the specific payment support details for each facility and may begin billing at the outbreak rate as instructed by Provider Relations at that time. The per diem increase for Appendix E PNMIs will increase the cap and will be reconciled when the regular annual audit is conducted.
For More Information:
Please contact Provider Relations Specialist, Tammy Usher at tammy.l.usher@maine.gov.