Maine Regulation Digest / MaineCare Section 97
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Private Non-Medical Institution Services
10-144 C.M.R. ch. 101 · MaineCare Benefits Manual · monitored nightly · Sources last checked 2026-09-02 04:24 EDT
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From MaineCare Benefits Manual, 10-144 C.M.R. ch. 101, as published by the Maine Secretary of State and read on an earlier revision. Quoted in part; the section itself is on maine.gov.
The purpose of these regulations is to define which items of expense will be taken into account and which will be excluded in the calculation of reasonable costs for Private Non-Medical Institutions. These Principles of Reimbursement for Private Non-Medical Institutions identify which costs are reimbursed under Chapter II, Section 97 - Private Non-Medical Institution (herein after, PNMI) Services of the MaineCare Benefits Manual. The Department will consider allowable costs identified by these Principles for reimbursement of services in a children’s residential care facility, substance use disorder treatment facility, and community residences for persons with mental illness (for those facilities covered under Appendices B, D, and E) on the first day of the provider’s fiscal year beginning on or after July 1, 2001. The Department will consider allowable costs identified by these Principles of Reimbursement for Private Non-Medical Institution medical and remedial facility services (under Appendices C and F) rendered on or after July 1, 2001. Prior to July 1, 2001, PNMI services rendered in a medical and remedial facility and non-case mixed medical and remedial facility shall follow the applicable appendix in effect prior to July 1, 2001, and the Principles of Reimbursement for Residential Care Facilities- Room and Board Costs.
1100 SCOPE/AUTHORITY
These Principles define scope and authority within the specific Appendix applicable to that type of Private Non-Medical Institution. These Principles define Department and member/resident in Section 10000 of this policy. These Principles define facility in each specific Appendix.
1300 ADULT FAMILY CARE HOMES
1300.1The Department does not use these PNMI Principles in the determination of reimbursable amount paid to Adult Family Care Homes.
1400 REQUIREMENTS FOR MAINECARE REIMBURSEMENT
In order to be reimbursed, all PNMIs identified as children’s residential care, substance use treatment, community residences for persons with mental illness, and Appendix F scattered site PNMIs for people for intellectual disabilities must be licensed as applicable, in accordance with the Mental Health Agency Licensing Standards and Rights of Recipients of Mental Health Services, Regulations for Licensing and Certification of Alcohol and Drug treatment Services, or Rules for the Licensure of Residential Child Care Facilities/Rights of Recipients of Mental Health Services Who are Children in Need of Treatment. In order to be reimbursed, medical and remedial service PNMIs and non-case mixed must be licensed by the Division of Licensing and Certification in the Department of Health and Human Services (See 10-149
C.M.R., Ch. 113). Appendix F, scattered site PNMIs for persons with intellectual disabilities, may be licensed as either a residential care facility or as a mental health provider in accordance with the Mental Health Agency Licensing Standards and Rights of Recipients of Mental Health Services, Regulations for Licensing and Certification of Alcohol and Drug treatment services.
1400.2All PNMIs must obtain licensure and a signed Provider/Supplier Enrollment Agreement with the Department of Health and Human Services, Office of MaineCare Services (OMS). Providers must submit a copy of the license accompanying the Provider/Supplier Enrollment Agreement to the Department.
1400.3Types of PNMIs considered for MaineCare reimbursement, subject to the availability of funds, include:
1400.3.1 Facilities providing Private Non-Medical Institution services to members with significant mental or physical disability requiring structured, individualized habilitative or rehabilitative in-home programming as outlined in the provider agreement with the PNMI.
1400.3.2 Facilities with licensed Private Non-Medical Institution beds at scattered locations serving a minimum of four eligible members, as long as the service provided consistently fits within the definition of the applicable appendix stated below.
[…] The section continues on maine.gov.
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