Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.06 - NONCOVERED SERVICES

Current through 2024-29, July 17, 2024
Services for which reimbursement is not allowed under
						this Section include, but are not limited to, the following:
20.06-1 Services not authorized by the Care
					 Plan.
20.06-2 Services to any
					 member who is hospitalized, a nursing facility resident, or ICF/IID
					 resident.
20.06-3 Any service
					 otherwise reimbursable under the
Rehabilitation Act of 1973
or
					 the
Individuals with Disabilities Education Act
, including but
					 not limited to job development and vocational assessment or
					 evaluations.
20.06-4 Room and
					 board; The term "room" means shelter-type expenses, including all property
					 related costs such as rental or purchase of real estate and furnishings,
					 maintenance, utilities, and related administrative services. The term "board"
					 means three meals a day or any other full nutritional regimen.
20.06-5 Services provided directly or
					 indirectly by the legal guardian.
20.06-6 Work Support or Employment Specialist
					 Services when the member is not engaged in employment. Employment means
					 traditional employment or telecommuting that is compensated at a competitive
					 wage, or self-employment or business ownership. A competitive wage is a wage at
					 or above the minimum wage, but not less than the customary wage and level of
					 benefits paid by the employer for the same or similar work performed by an
					 employee without a disability. Employment does not include work in a setting in
					 which the member has little or no interaction with customers or other employees
					 not having a disability, unless the member is telecommuting, self-employed, or
					 owns his or her own business.
20.06-7 Specialized Medical Equipment and
					 Supplies, Communication Aids, or Home Accessibility Adaptations unless the
					 service has been determined non-reimbursable under Section
					 60, Medical Supplies and Durable
					 Medical Equipment or other sections of the
MaineCare Benefits
					 Manual.
2 0.06-8
					 Non-Duplication of Services; Services as defined under this section if the
					 member is receiving comparable or duplicative services under this or another
					 section of the
MaineCare Benefits Manual
. A member may not
					 receive services under this section, if the member is in a residential
					 treatment facility or if the member is receiving services in an institution,
					 including, but not limited to Section 2, Adult Family Care Services; Section
					 45, Hospital Services; Section 46, Psychiatric Hospital Services; Section 50, I
					 CF/IID; Section
					 67, Nursing Facilities and Section
					 97, Private Non-Medical Institutions. A member may not receive services if they
					 are in another Home and Community Based Waiver such as Section
					 19, Home and Community-Based
					 Benefits for the Elderly and for Adults with Disabilities, Section 21, Home and
					 Community Benefits for Members with Intellectual Disabilities or Autistic
					 Disorder, Section
					 22, Home and Community Benefits
					 for the Physically Disabled, Section 29, Support Benefits for Adults with
					 Intellectual Disabilities or Autistic Disorder and Section
					 32, Waiver Services for Children
					 with Intellectual Disabilities or Pervasive Developmental Disorders.