Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Attachment A - DESCRIPTION OF ITEMS AND SERVICES THAT ARE COVERED BY THE FACILITY'S DAILY RATE

Current through 2024-29, July 17, 2024
The items and services that will be covered by the daily rate
				  at this Facility are based on the Resident's medical needs and depend in part
				  on how the Resident will be paying for his or her care. The chart below
				  summarizes what items and services are currently covered by the daily rate for
				  the different payment sources. An "X" means that the item or service is covered
				  by the Facility's daily rate. These items and services may change from time to
				  time based on changes in Federal or State law and regulation.
This Facility is required to complete this chart for
				  all three payment sources.
The Facility should also be able to supply a
				  list of fees charged for any service or item that is listed below but not
				  covered by the Facility's daily rate.
Item or Service:
Payment Source:
Medicaid
Medicare
Private
1. Medical Supplies and Durable Medical
							 Equipment, including but not limited to:
Alcohol
X
Alternating pressure pads, air mattresses, "Egg
							 Crate" mattresses, gel mattresses
X
Applicators
X
Bandages, including bandaids and gauze
							 bandages
X
Basins
X
Beds (standard hospital type) and bed rails
X
Bed pans
X
Blood pressure equipment
X
Bottles (water)
X
Canes
X
Catheters and catheter trays (disposable)
X
Chairs (standard, geriatric)
X
Commodes
X
Corner chair
X
Cotton
X
Crutches
X
Cushions (e.g., comfort rings)
X
Disinfectants
X
Douche trays (disposable)
X
Dressings
X
Enema equipment
X
Glucometer
X
General services such as administration of oxygen
							 and related medications, hand feeding, incontinency care, tray service and
							 enemas
X
Gloves (sterile and unsterile)
X
Gowns
X
Ice bags
X
Incontinent supplies (including Chux, Attends,
							 Pampers, plastic pants, liners, etc., all sizes)
X
Irrigation trays
X
Non-prescription medications, including analgesics,
							 Antacids, artificial tears, calcium supplements, cough syrups and expectorants,
							 dietary supplements (including special dietary supplements), hemorrhoid
							 preparations, iron supplements, laxatives, lotions, lubricants, ointments
							 including petroleum jelly, powders (medicated and baby), sunscreen,
							 suppositories, vitamins and non-prescription supplies for decubiti
X
Oxygen, for emergency and as necessary
X
Parenteral/enteral feedings
X
Pillows
X
Pitchers (water)
X
Prone boards
X
Rectal medicated wipes
X
Restraints (posey, thoracic chest supports, tilt in
							 space, Wedge pillows, etc.)
X
Sheepskin
X
Shower chairs and tub seats
X
Specimen containers
X
Sterile I.V. or irrigation solutions
X
Stethoscope
X
Suture sets
X
Swabs, medicated or unmedicated
X
Syringes and needles
X
Tapes
X
Testing materials to be used by staff of
							 Facility
X
Thermometers
X
Tongue depressors
X
Traction equipment
X
Trapezes
X
Tubes (gavage, lavage, etc.)
X
Underpads
X
Urinals
X
Urinary drainage equipment and supplies
							 (disposable)
X
Walkers
X
Wheelchairs (standard, pediatric, "hemi" chairs,
							 reclining wheelchairs)
X
2. Routine personal hygiene items and services
							 as required to meet the needs of the Resident, including but not limited
							 to:
Bathing services
X
Bath soap
X
Brush
X
Comb
X
Cotton balls
X
Cotton swabs
X
Dental floss
X
Denture adhesive
X
Denture cleaner
X
Deodorant
X
Disinfecting soaps or specialized cleansing agents
							 when indicated to treat special skin problems or fight infection
X
Moisturizing lotion
X
Mouthwash
X
Razor
X
Routine hair hygiene services
X
Routine nail hygiene services
X
Sanitary napkins and related supplies
X
Shampoo
X
Shaving cream
X
Soap
X
Tissues
X
Toothbrush
X
Toothpaste
X
Towels
X
Washcloths
X
3. Basic personal laundry
							 services
X
4. Room/bed maintenance services
X
5. Routine activities programs that are
							 required to be provided by the Facility to meet the interests and physical,
							 mental and psychosocial well-being of the Resident
X
6. Routine transportation of the Resident or
							 laboratory specimens to hospital or doctors' offices
X
7. Other personal items and
							 services
Barber and beautician services
Personal clothing other than gowns
Telephone
Television
OTHER