LD 1951
pg. 2
Page 1 of 4 An Act To Establish Guidelines and Criteria for Audits Conducted by the Departm... Page 3 of 4
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LR 2882
Item 1

 
4.__Determination of "ordinary," "necessary" or "reasonable"
costs.__In making findings concerning whether costs are
"ordinary," "necessary" or "reasonable," the office of audit
shall consider any practice, type, quantity, frequency or price
level of an expenditure to be reasonable, ordinary and necessary
if the expenditure meets any of the following standards.

 
A.__A substantial number of providers of health care or
community services in Maine incur costs of similar
magnitude, frequency, quantity or price level to the costs
under review.

 
B.__The expenditure is reasonably incurred to produce,
accomplish, facilitate or compensate persons for providing
an item or service related to the purpose of a program or
activity for which the State has contracted or for which the
State otherwise provides payment.

 
C.__The expenditure is comparable to one incurred by a
department or agency of the State responsible for services
or programs similar to those to which the finding applies.

 
D.__The expenditure, when considered in combination with all
amounts expended for the program under review, results in an
overall cost that is reasonable relative to other providers
of the same or similar items or services, taking into
account any special needs of the population served and any
innovative or specialized services offered by a particular
provider.

 
5.__Employee compensation and benefit costs.__In evaluating
the reasonableness and allowability of employee wages, salaries
and benefits, the department shall apply the following criteria.

 
A.__The department may not disallow any employee benefits,
wages or salaries, or any expenditures as described in
paragraph B, if the total of employee salaries, wages,
benefits and expenses described in paragraph B is less than
or equal to the total cost of wages, salaries, benefits and
expenses described in paragraph B for employees of the State
performing similar functions.__This paragraph may not be
construed to require disallowance of greater compensation
costs that are otherwise reasonable under applicable facts
and circumstances.

 
B.__The department shall modify its rules governing MaineCare
reimbursement and reimbursement pursuant to grants, contracts or
otherwise for health care providers and other agencies providing
community services.__The office of audit shall interpret any
existing provisions of the


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