Nursing Facility Rate Reform Update: NF Rate Letters Now Posted, Updated Billing Guidance Available, DHHS Request to Hold January Claims

• By: Angela Westhoff
• On: 01/16/2025 15:55:21
• In: Legislative/Government Affairs

Nursing Facility, Section 67, rate letters for 2025 are now posted online. The new rate letters reflect the Department's new rate model and the move to a state pricing model. Please be sure to review your rate letter and contact MaineCare Provider Specialist, Bruce Cosgrove at Bruce.Cosgrove@maine.gov with any questions or concerns. Rates should reflect the estimates that were distributed to nursing facilities in November.

On January 16^th, the Office of MaineCare Services held a webinar for nursing facility billing and technical assistance questions. The webinar recording will be posted on the Department's Rate Reform website available here. (Look for the “Rate Reform in Progress” section and scroll down to the Nursing Facilities- Section 67 section). An FAQ document will also be developed and shared later this month. There is one more office hour session scheduled for January 28^th at 11:00 AM. Please register in advance for this webinar. Registration link can be found here.
 
Also, please note that attendees are encouraged to email questions in advance to LTSS Initiatives Manager, Amanda.Nelson@maine.gov, to ensure they are answered on the call, but it's not required. As a reminder, these meetings are for providers and their billing staff and/or billing vendors to ask technical billing questions in preparation for the new case mix system (PDPM). Questions related to the NF Rate Reform model or to the rule making process will not be addressed at this meeting.

The Department's PDPM Billing Guide is available here to assist providers with the new case mix system, specific to the Nursing Component of the Patient Driven Payment Model (PDPM). Billing under the new model is expected to be operational by February 1, 2025. In a recent notice, the Department is requesting that providers please hold claims for services delivered in January 2025 until these changes are implemented and announced in a future notice.

MHCA has requested end-to-end claims testing for the new system; however, the Department's vendor is not able to do this. If providers do experience any claims denials in February when they begin to bill, you should contact you MaineCare specialist right away for assistance and we are told that providers can resubmit the claim again the next day. Please do keep MHCA informed of any issues you experience with the new billing system. We want to assist and advocate for swift resolutions so reimbursement/ cash flow is not interrupted. Thank you.

Staff contact: awesthoff@mehca.org