September 1, 2011
MEMORANDUM
TO:Providers of MaineCare Private Non-Medical Institution (PNMI) Services
FROM:Mary C. Mayhew, Commissioner, Department of Health and Human Services
SUBJECT: PNMI Services that meet Institution for Mental Disease (IMD) Guidelines
The Department recentlyreceived a letter from the Centers for Medicare and Medicaid Services (CMS) (see attached) informing us that some PNMI facilities appear to fit the definition of an Institution for Mental Disease (IMD) (42 CFR 435.1010). IMD services are not generallyreimbursable under Medicaid for populations between the ages of 21 and 65. The Department has been asked to submit a list of facilities that meet this definition and to stop claiming federal match for those services immediately.
To help determine whether a facility meets these IMD criteria, CMS referred us to a series of additional questions that are referenced in the CMS State Medicaid Manual, Section 4390. These criteria are about other characteristics of the facility, such as ownership, governing body, licensure and geographic and programmatic independence from other services provided by the same agency.
The Department is gathering all of the information it can from current enrollment and licensing information on file. However, we may need your assistance to respond to CMS. If your agency is licensed for more than 16 PNMI beds (single or aggregate sites), it is likely that you will receive a call from staff under contract with DHHS MaineCare Services. These calls will start on or after September 7, 2011. Please be prepared to designate a contact person and make your staff aware that this call requires immediate response from your agency. The Department must respond to CMS within 60 days.
If you have any questions, please feel free to contact Patty Dushuttle at 207-287-9362 or Margaret Brown at 207-287-5505. Thank you for working with us to identify which facilities meet the IMD definition.
MCM/klv
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