reglab/statecodes huggingface dataset:
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 III - Allowances for Services › Section 144-101-III-13 - Allowances for Targeted Case Management Services

Current through 2024-29, July 17, 2024
PROC CODE
MOD
DESCRIPTION
UNIT OF SERVICE
MAXIMUM ALLOWANCE Through 7/31/18
MAXIMUM ALLOWANCE 8/1/18-6/30/19*
MAXIMUM ALLOWANCE From 7/1/19*
TARGETED CASE MANAGEMENT CODES
T1017
UD
CASE MANAGEMENT SERVICES FOR CHILDREN WITH
								DEVELOPMENTAL DISABILITIES
15 Minutes
$21.52
$21.99
$21.95
T1017
UC
CASE MANAGEMENT SERVICES FOR MEMBERS CHILDREN WITH
								BEHAVIORAL HEALTH DISORDERS
15 Minutes
$21.52
$21.99
$21.95
T1017
UB
CASE MANAGEMENT SERVICES FOR CHILDREN WITH CHRONIC
								MEDICAL CARE NEEDS
15 Minutes
$21.52
$21.99
$21.95
G9012
HI
CASE MANAGEMENT SERVICES FOR ADULTS WITH
								DEVELOPMENTAL DISABILITIES -
15 MINUTES
$21.52
$21.99
$21.95
T1017
HF
CASE MANAGEMENT SERVICES FOR ADULTS WITH SUBSTANCE
								ABUSE DISORDERS
15 minutes
$21.52
$21.99
$21.95
T1017
CASE MANAGEMENT SERVICES FOR ADULTS WITH HIV
15 MINUTES
$21.52
$21.99
$21.95
T1017
U5
CASE MANAGEMENT SERVICES FOR MEMBERS EXPERIENCING
								HOMELESSNESS
15 MINUTES
$21.52
$21.99
$21.95
G9012
U5
CASE MANAGEMENT SERVICES FOR MEMBERS EXPERIENCING
								HOMELESSNESS (Government Agencies)
15 MINUTES
$21.52
$21.99
$21.95
*The Department is seeking and anticipates receiving CMS
					 approval for this Section. Pending approval, the Department will reimburse
					 providers under the new increased rate retroactively to 8/1/2018 pursuant to
					 P.L. 2017, ch. 460, Part D. Providers must ensure that the increase in
					 reimbursement rates effective August 1, 2018 is applied in full to wages and
					 benefits for employees who provide direct services. Providers must document
					 compliance with this requirement in their financial records and provide such
					 documentation to the Department upon request.
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 III - Allowances for Services › Section 144-101-III-17 - Allowances for Community Support Services

Current through 2024-29, July 17, 2024
PROC CODE
DESCRIPTION
UNIT
MAXIMUM ALLOWANCE
MAXIMUM ALLOWANCE
MAXIMUM ALLOWANCE
HIPAA CODES
Section 17 Services
RATE through 7/31/2018*
RATE from 8/1/18 to 6/30/19**
RATE from 7/1/19**
H2015
Comprehensive Community Support Services
(Community Integration Services)
15 minutes
$20.86
$21.32
$21.28
H0040
Assertive Community Treatment
(Assertive Community Treatment)
Per Diem
By Report
By Report
By Report
H0038
CIPSS-Self Help/peer services
15 minutes
$11.10
$11.34
$11.32
H2017
Psychosocial Rehabilitation
(Daily Living Support Services)
15 minutes
$7.77
$7.94
$7.93
H2018
Psychosocial Rehabilitation Service
(Community Rehabilitation Services )
Per Diem
$74.39
$76.01
$75.88
H2014
Skills Training and Development
(Skills Development Services)
15 minutes
$12.20
$12.46
$12.44
H2014 HQ
Skills Training and Development
(Skills Development Services)
15 minutes
$3.05
$3.32
$3.11
H2025
Ongoing Support to Maintain Employment
(Skills Development Services/training)
15 minutes
$12.20
$12.46
$12.44
H2012
Behavioral Health Day Treatment
(Day Support Services)
Per hour
By Report
By Report
By Report
*The Department is seeking and anticipates receiving CMS
					 approval for this Section. Pending approval, the Department will reimburse
					 providers under the new increased rate retroactively to 7/1/2016 through
					 7/31/2018 pursuant to P.L. 2015, ch. 477 (eff. Apr. 15, 2016).
**The Department is seeking and anticipates receiving CMS
					 approval for this Section. Pending approval, the Department will reimburse
					 providers under the new increased rate retroactively to 8/1/2018 pursuant to
					 P.L. 2017, ch. 460, Part D. Providers must ensure that the increase in
					 reimbursement rates effective August 1, 2018 is applied in full to wages and
					 benefits for employees who provide direct services. Providers must document
					 compliance with this requirement in their financial records and provide such
					 documentation to the Department upon request.
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 III - Allowances for Services › Section 144-101-III-18 - Allowances for Home and Community-Based Services for Adults with Brain Injury

Current through 2024-29, July 17, 2024
PROC
CODE
MODIFIER
DESCRIPTION
UNIT
MAXIMUM ALLOWANCE
97755
U9
Assistive Technology-Assessment
1/4 hour
$14.44
T2035
U9
Assistive Technology-Transmission (Utility
								Services)
Month
$50.00 per month
A9279
U9
Assistive Technology-(Monitoring feature/device,
								stand alone or integrated, any type, includes all accessories, components and
								electronics, not otherwise classified)
Per device
T1016
U9
Care Coordination (Case Management)
1/4 hour
$ 17.00
T2015
U9
Career Planning (Habilitation,
								prevocational)
per hour
$ 28.00
97537
U9
Community/Work Reintegration-Individual
1/4 hour
$ 14.05
97537
U9 HQ
Community/Work Reintegration-group
1/4 hour
$ 9.37
T2019
U9
Employment Specialist Services (Habilitation,
								supported employment waiver)
1/4 hour
$ 7.49
T2016
U9
Home Support (Residential Habilitation)Level
								II
Per Diem
$ 301.39
T2016
U9 TG
Home Support (Residential Habilitation)Level III-
								Increased Neurobehavioral
Per Diem
$ 489.61
T2017
U9
Home Support (Residential Habilitation)Level
								I
1/4 hour
$ 6.33
T2017
U9QC
Home Support (Residential Habilitation)-Remote
								Support-Monitor Only
1/4 hour
$ 1.63
T2017
U9 GT
Home Support (Residential Habilitation)-Remote
								Support-Interactive Support
1/4 hour
$ 6.33
97535
U9
Self Care/Home Management
								Reintegration-Individual
1/4 hour
$14.52
97535
U9 HQ
Self Care/Home Management
								Reintegration-Group
1/4 hour
$ 9.68
S5102
U9
Work Ordered Day Club House (Adult Day Care)
Per Diem
$65.00
H2023
U9
Work Support (Supported
								Employment)-Individual
1/4 hour
$6.91
MODIFIERS
DESCRIPTIONS
U9
Indicates Section
								18 Services
GT
Remote Support-Interactive Support
QC
Remote Support-Monitor Only
HQ
Group Setting
TG
Complex/high tech level of care
* The effective date of this rate change is retroactive to
					 4/15/16.
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 III - Allowances for Services › Section 144-101-III-20 - Allowances for Home and Community Based Services for Adults with Other Related Conditions

Current through 2024-29, July 17, 2024
PROC
CODE
MODIFIER
DESCRIPTION
UNIT
MAXIMUM ALLOWANCE
T1016
U8
Care Coordination (Case Management)
1/4 hour
$17.00
T2021
U8
Community Support (Day Habilitation)
1/4 hour
$5.33*
T2016
U8
Home Support (Residential Habilitation)
Per Diem
$287.91*
T2017
U8
Home Support (Residential Habilitation)
1/4 hour
$6.39*
T2017
U8 QC
Home Support (Residential Habilitation)-Remote
								Support-Monitor Only
1/4 hour
$1.63*
T2017
U8 GT
Home Support (Residential Habilitation)-Remote
								Support-Interactive Support
1/4 hour
$6.39*
T1019
U8
Personal Care
1/4 hour
$ 3.78*
H2023
U8
Work Support (Supported Employment)
1/4 hour
$ 6.91
T2019
U8
Employment Specialist Services
								(Habilitation-Supported Employment)
1/4 hour
$7.49*
97755
U8
Assistive Technology-Assessment
1/4 hour
$16.04
T2035
U8
Assistive Technology-Transmission (Utility
								Services)
Month
Up to $50.00 per month
A9279
U8
Assistive Technology-(Monitoring feature/device,
								stand alone or integrated, any type, includes all accessories, components and
								electronics, not otherwise classified)
Upto $6,000.00 annually
V5274
U8
Communication Aids
Per invoice
G9007
U8 GN
Consultation -Speech
1/4 hour
$5.40
G9007
U8 GO
Consultation -Occupational Therapy
1/4 hour
$5.40
G9007
U8 GP
Consultation -Physical Therapy
1/4 hour
$5.40
H0031
U8
Consultation -Psychological (Psychologist,
								Psychological Examiner)
1/4 hour
$19.80
G9007
U8 HI
Consultation -Behavioral (LCSW, LCPC)
1/4 hour
$13.50
S5165
U8
Home Accessibility Adaptations (Home
								Modifications)
Per invoice
S5165
U8 CG
Home Accessibility Adaptations (Home
								Modifications)-Repairs
Per invoice
T2029
U8
Specialized Medical Equipment
Per invoice
S8990
U8 GO
Maintenance-Occupational Therapy
1/4 hour
$9.54
S8990
U8 GN
Maintenance-Speech Therapy
1/4 hour
$12.48
S8990
U8 GP
Maintenance-Physical Therapy
1/4 hour
$9.72
92507
U8
Non-Traditional Communication-Assessment (Treatment
								of speech, language, voice, communication, and or auditory processing disorder;
								individual)
1/4 hour
$9.00
G9007
U8
Non-Traditional Communication-Consultation
1/4 hour
$9.00
T2015
U8
Career Planning (Habilitation,
								prevocational)
Per Hour
$28.00**
Table for Modifiers
GT
Remote Support-Interactive Support
QC
Remote Support-Monitor Only
GN
Speech Therapy Services
GO
Occupational Therapy Services
GP
Physical Therapy Services
HI
Behavioral Services
CG
Repairs
U8
All Section
								20 Services
* The effective date of this rate change is retroactive to
					 April 15, 2016.
** The effective date of this rate change is March 1, 2017
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1000 - PURPOSE

Current through 2024-29, July 17, 2024
The purpose of these regulations is to describe the
						  reimbursement methodology for Home and Community Based Services waiver
						  providers whose services are reimbursed in accordance with Chapters II and III,
						  Section
						  21, "Home and Community Benefits
						  for members with Intellectual Disabilities or Autism Spectrum Disorder" of the
MaineCare Benefits Manual
. These Principles govern
						  reimbursement for services provided on or after December 30, 2007. All services
						  reimbursed in this section are considered fee for service.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1050 - DEFINITIONS

Current through 2024-29, July 17, 2024
Fee for service
- is a method of paying
						  providers for covered services rendered to members. Under this fee for service
						  system, the provider is paid for each discrete service described in Appendix I
						  to a member.
Per Diem -
A day is defined as beginning
						  at midnight and ending twenty-four (24) hours later. However, per diem Home
						  Support services may be provided by more than one entity in a twenty-four hour
						  period. On days when a member is transitioning between providers of home
						  support, only the provider providing home support services at 11:59 p.m. may
						  bill for home support for that day. Per Diem reimbursement is allowable to a
						  Home Support Provider who provides Direct support at some point during that
						  day, if the member transfers to an environment that is not being reimbursed for
						  Home Support for that same time period.
Week
- A week is equal to seven
						  consecutive days starting with the same day of the week as the provider's
						  payroll records, usually Sunday through Saturday.
Year-
Services are authorized based on the
						  state fiscal year, July 1 through June 30.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1100 - AUTHORITY

Current through 2024-29, July 17, 2024
The authority of the Department to accept and
						  administer any funds that may be available from private, local, State or
						  Federal sources for services under this Chapter is established in
						  22 M.R.S.A.
						  §§10,
						  12,
						  and
						  3173.
						  The authority of the Department to adopt rules to implement this Chapter is
						  established under
						  22 M.R.S.A.
						  §§12,
						  42(l),
						  and
						  3173.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1200 - COVERED SERVICES

Current through 2024-29, July 17, 2024
Covered Services are defined in Chapter II, Section
						  21 of the
MaineCare
						  Benefits Manual
.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1300 - REIMBURSEMENT METHODS

Current through 2024-29, July 17, 2024
Services covered under this section will
						  be
reimbursed on a fee for service basis using one of these methods as
						  follows:
1.
Standard Unit
						Rate
A Standard unit rate is the rate paid per unit of time (an hour, a
						specified portion of an hour, or a day) for a specific service. Services paid
						for using a standard rate are as follows:
A.
						Assistive Technology-Assessment;
B.
						Assistive Technology-Transmission (Utility Services);
C. Career Planning;
D. Community Support Services
E. Communication Aids-Ongoing Visual-Gestural
						and Augmented Communications;
F.
						Consultation Services;
G.
						Counseling;
H. Crisis
						Intervention;
I. Crisis
						Assessment;
J. Employment
						Specialist Services;
K. Home
						Support-Agency;
L. Home
						Support-Quarter Hour (1/4 hour);
M.
						Home Support-Family-Centered Support;
N. Home Support-Remote Support- Monitor
						Only;
O. Home Support-Remote
						Support- Interactive Support;
P.
						Non-Traditional Communication Consultation;
Q. Non-Traditional Communication Assessments;
R. Occupational Therapy
						(Maintenance) Service;
S. Physical
						Therapy (Maintenance) Service;
T.
						Shared Living;
U. Speech Therapy
						(Maintenance) Service-Individual;
V. Speech Therapy (Maintenance)
						Service-Group;
W. Work Support-
						Individual;
X. Work Support-Group;
The standard rates for these services are listed in
						  Appendix I.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1400 - CALCULATION OF THE PER DIEM RATE FOR AGENCY HOME SUPPORTS

Current through 2024-29, July 17, 2024
If the number of Agency Home Support hours provided by
						  the facility in a week is no less than 92.5 % and no more than 105% of the
						  total hours authorized for members in the facility, the provider will be paid
						  at the per diem rate.
If the amount of Agency Home Support hours actually
						  provided to all members in the facility in a given week is less than 92.5% of
						  the hours authorized for those members, the agency's per diem rate will be
						  adjusted to reflect the number of hours actually provided to the members in the
						  facility in that week. In that case, the agency's per diem rate for that week
						  will be determined by adding all of the authorized weekly hours for members in
						  the facility, multiplying by the Agency Home Support rate listed in Appendix I
						  and dividing by seven. The result is then divided by the number of members in
						  the facility to determine a per diem rate applicable to each member for that
						  week.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1600 - REQUIREMENTS FOR PARTICIPATION IN MAINECARE PROGRAM

Current through 2024-29, July 17, 2024
Providers must comply with all requirements as outlined
						  in Chapter 1 and Chapter II, Section
						  21 of the
MaineCare
						  Benefits Manual
.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1700 - RESPONSIBILITIES OF THE PROVIDER

Current through 2024-29, July 17, 2024
Providers are responsible for maintaining adequate
						  financial and statistical records and making them available when requested for
						  inspection by an authorized representative of the DHHS, Maine Attorney
						  General's Office or the Federal government. Providers shall maintain accurate
						  financial records for these services separate from other financial
						  records.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1800 - RECORD KEEPING AND RETENTION OF FINANCIAL RECORDS

Current through 2024-29, July 17, 2024
When fiscal records are requested, providers have ten
						  (10) business days to produce the requested record to DHHS. Complete
						  documentation shall mean clear written evidence of all transactions of the
						  provider entities related to the delivery of these services, including but not
						  limited to daily census data, invoices, payroll records, copies of governmental
						  filings, staff schedules, time cards, and member service charge schedule, or
						  any other record necessary to provide the Commissioner with the highest degree
						  of confidence that such services have actually been provided. The provider
						  shall maintain all such records for at least five (5) years from the date of
						  reimbursement.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1900 - BILLING PROCEDURES

Current through 2024-29, July 17, 2024
Providers will submit claims to MaineCare and be
						  reimbursed at the applicable rate for the service in accordance with MaineCare
						  billing instructions for the CMS 1500 claim form.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-1910 - WORK SUPPORT GROUP RATE

Current through 2024-29, July 17, 2024
When billing for Work Support Services-Group the per
						  person rate is based on the number of members served as follows:
When billing, use of the appropriate modifiers from
						  Appendix I is necessary for payment.
The Department is seeking and anticipates receiving
						  approval from the federal Centers for Medicare and Medicaid Services for these
						  changes. Pending approval, the changes will be effective July 1, 2018.
Members in Group
Rate per Unit Effective
									 1/1/22*
2
$4.45*
3
$2.96*
4
$2.22*
5
$1.77*
6
$1.48*
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-2000 - AUDIT OF SERVICES PROVIDED

Current through 2024-29, July 17, 2024
The Department shall monitor provider's claims for
						  reimbursement by randomly reviewing the claim for services and verifying hours
						  actually provided by collecting documentation from providers. Documentation
						  will be requested from providers that correspond to dates of service on claims
						  submitted for reimbursement as follows:
a)
Payroll Records
-
						Documentation showing the number of hours paid to an employee that covers the
						period of time for which the Direct Care hours are being requested.
b)
Staffing Schedules per
						Facility
- Documentation showing the hours and the name of the direct
						care staff scheduled to work at the facility.
c)
Member Records
-
						Documentation that supports the service delivery of services that a member
						received.
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 III - Allowances for Services › Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-21-2100 - RECOVERY OF PAYMENTS

Current through 2024-29, July 17, 2024
The Department may recover any amounts due the
						  Department based on Chapter I of the
MaineCare Benefits
						  Manual
.
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 III - Allowances for Services › Section 144-101-III-22 - Home and Community Benefits for the Physically Disabled (Repealed)

Current through 2024-29, July 17, 2024
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 III - Allowances for Services › Section 144-101-III-23 - Developmental and Behavioral Clinic Services (Repealed)

Current through 2024-29, July 17, 2024
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 III - Allowances for Services › Section 144-101-III-24 - Day Habilitation Services for Persons with Mental Retardation (absorbed by Ch. III Section 28)

Current through 2024-29, July 17, 2024
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 III - Allowances for Services › Section 144-101-III-25 - Allowances for Dental Services (Repealed)

Current through 2024-29, July 17, 2024
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 III - Allowances for Services › Section 144-101-III-26 - Day Health Services

Current through 2024-29, July 17, 2024
The Department is seeking and anticipates receiving the
					 Centers for Medicare and Medicaid Services' (CMS) approval for this section.
					 Pending approval, the rates will be effective as follows:
PROC.
CODE
DESCRIPTION
MAXIMUM ALLOWANCE Effective Prior to 8/1/18
MAXIMUM ALLOWANCE Effective 8/1/18 to
								6/30/19
MAXIMUM ALLOWANCE Effective 7/1/19*
REMARKS
S5100 HC
Day Care Services
$3.14
$3.48
$3.45
Per 15 mins
*Pursuant to P.L. 2017, ch. 460, Part B, Sec. B-2:
					 Effective July 1, 2019, payment rates attributable to wages and salaries for
					 personal care and related services will be increased annually by an inflation
					 adjustment cost-of-living percentage in accordance with the United States
					 Department of Labor, Bureau of Labor Statistics Consumer Price Index, Medical
					 care services (professional services, nursing home and adult day care services)
					 from the prior December. These cost of living increases shall continue annually
					 until the Department has completed a rate study for adult family care services,
					 adult day services or homemaker services and the rates in the rate study have
					 been implemented.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1000 - PURPOSE

Current through 2024-29, July 17, 2024
The purpose of these regulations is to describe the
						  reimbursement methodology for Home and Community Based Services waiver
						  providers whose services are reimbursed in accordance with Chapters II and III,
						  Section
						  29, Support Services for Adults
						  with Intellectual Disabilities or Autism Spectrum Disorder of the
MaineCare Benefits Manual
. All services reimbursed in this
						  section are considered fee for service.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1100 - DEFINITIONS

Current through 2024-29, July 17, 2024
Fee-for-service -
is a method of paying
						  providers for covered services rendered to members. Under this fee-for-service
						  system, the provider is paid for each discrete service described in Appendix I
						  to a member.
Per Diem -
A day is defined as beginning
						  at midnight and ending twenty-four (24) hours later.
Week
- A week is equal to seven
						  consecutive days starting with the same day of the week as the provider's
						  payroll records, usually Sunday through Saturday.
Year -
Services are authorized based on
						  the state fiscal year, July 1 through June 30.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1200 - AUTHORITY

Current through 2024-29, July 17, 2024
The authority of the Department to accept and
						  administer any funds that may be available from private, local, State or
						  Federal sources for services under this Chapter is established in
						  22 M.R.S.A.
						  §3173. The authority of the Department
						  to adopt rules to implement this Chapter is established under
						  22 M.R.S.
						  §§42(l) and
						  3173.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1300 - COVERED SERVICES

Current through 2024-29, July 17, 2024
Covered Services are defined in Chapter II, Section
						  29 of the
MaineCare
						  Benefits Manual
.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1400 - REIMBURSEMENT METHODS

Current through 2024-29, July 17, 2024
Services covered under this section will be reimbursed
						  on a fee-for-service basis using one of these methods as follows:
1.
Standard Unit rate -
A
						Standard unit rate is the rate paid per unit of time (an hour, a specified
						portion of an hour, or a day) for a specific service. Services in the standard
						rate include:
A. Assistive
						Technology-Assessment;
B. Assistive
						Technology-Transmission (Utility Services);
C. Career Planning;
D. Community Support Services;
E. Employment Specialist Services;
F. Home Support-Quarter Hour:
G. Home Support-Remote Support-Interactive
						Support;
H. Home Support-Remote
						Support-Monitor Only;
I. Respite,
						1/4 hour and per diem;
J. Shared
						Living;
K. Work
						Support-Individual;
L. Work
						Support-Group.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1500 - REQUIREMENTS FOR PARTICIPATION IN MAINECARE PROGRAM

Current through 2024-29, July 17, 2024
Providers must comply with all requirements as outlined
						  in Chapter 1, General Administrative Policies and Procedures and Chapter II,
						  Section
						  29 of the
MaineCare
						  Benefits Manual
.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1600 - RESPONSIBLITIES OF THE PROVIDER

Current through 2024-29, July 17, 2024
Providers are responsible for maintaining adequate
						  financial and statistical records and making them available when requested for
						  inspection by an authorized representative of the DHHS, Maine Attorney
						  General's Office or the Federal government. Providers shall maintain accurate
						  financial records for these services separate from other financial
						  records.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1700 - RECORD KEEPING AND RETENTION OF FINANCIAL RECORDS

Current through 2024-29, July 17, 2024
Upon request, providers have ten (10) business days to
						  produce fiscal records to DHHS. Complete documentation shall mean clear written
						  evidence of all transactions of the provider and affiliated entities, including
						  but not limited to daily census data, invoices, payroll records, copies of
						  governmental filings, staff schedules, time cards, member service charge
						  schedule and amounts reimbursement by service, or any other record which is
						  necessary to provide DHHS with the highest degree of confidence in the
						  reliability of the costs of providing services. For purposes of this
						  definition, affiliated entities shall extend to management and other entities
						  for which any reimbursement is claimed, whether or not they fall within the
						  definition of related parties.
The provider shall maintain all such records for at
						  least five (5) years from the date of reimbursement.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1800 - BILLING PROCEDURES

Current through 2024-29, July 17, 2024
Providers will submit claims to MaineCare and be
						  reimbursed at the applicable rate for the service in accordance with MaineCare
						  billing instructions for the CMS 1500 claim form.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1810 - Work Support-Group Rate

Current through 2024-29, July 17, 2024
When billing for Work Support Services-Group the per
						  person rate is based on the number of members served as follows:
Members in Group
Rate per Unit Effective
									 1/1/22*
2
$6.23
3
$4.68
4
$3.82
5
$3.33
6
$2.98
*The Department is seeking approval from the federal
						  Centers for Medicare and Medicaid Services ("CMS") for these
						  changes.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-1900 - AUDIT OF SERVICES PROVIDED

Current through 2024-29, July 17, 2024
The Department shall monitor provider's claims for
						  reimbursement by randomly reviewing the claim for services and verifying hours
						  actually provided by collecting documentation from providers. Documentation
						  will be requested from providers that corresponds to dates of service on claims
						  submitted for reimbursement as follows:
A. Payroll Records - Documentation showing
						the number of hours paid to an employee that covers the period of time for
						which the Direct Care hours are being requested.
B. Staffing Schedules per facility -
						Documentation showing the hours and the name of the direct care staff scheduled
						to work at the facility.
C. Member
						Records - Documentation that supports the delivery of services that a member
						received.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Subsection 144-101-III-29-2000 - RECOVERY OF PAYMENTS

Current through 2024-29, July 17, 2024
The Department may recover any amounts due the
						  Department based on Chapter I of the
MaineCare Benefits
						  Manual
.
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 III - Allowances for Services › Section 144-101-III-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › GENERAL PROVISIONS › Appendix 144-101-III-29-I

Current through 2024-29, July 17, 2024
APPENDIX I
PROCEDURE CODE
SERVICE
MAXIMUM ALLOWANCE Effective
									 1/1/22
T2017
Home Support-Quarter Hour
$10.45 per 1/4 hour*
T2017 QC
Home Support-Remote Support-Monitor Only
$2.93 per 1/4 hour*
T2017 GT
Home Support-Remote Support-Interactive
									 Support
$10.45 per 1/4 hour*
S5140
Shared Living (Foster Care, adult)-Shared
									 Living Model-One member served
$163.71 per diem*
S5140 UN
Shared Living (Foster Care, adult)-Shared
									 Living Model-Two members served
$122.78 per diem*
T2021
Community Support (Day Habilitation)
$6.53 per 1/4 hour
T2021 SC
Community Support (Day Habilitation)- with
									 Medical Add On
$8.05 per 1/4 hour
T2019
Employment Specialist Services (Habilitation,
									 Supported Employment waiver)
$14.41 per 1/4 hour*
T2019 SC
Employment Specialist Services (Habilitation,
									 Supported Employment waiver)-with Medical Add On
$14.41 per 1/4 hour*
H2023
Work Support (Supported
									 Employment)-Individual
$12.59 per 1/4 hour*
H2023 SC
Work Support (Supported Employment)-Individual
									 with Medical Add On
$12.59 per 1/4 hour*
H2023 UN
Work Support (Supported Employment)-Group 2
									 members served
$6.23 per 1/4 hour*
H2023 UP
Work Support (supported employment)-Group 3
									 members served
up to $4.68 per 1/4 hour*
H2023 UQ
Work Support (supported employment)-Group 4
									 members served
up to $3.82 per 1/4 hour*
H2023 UR
Work Support (supported employment)-Group 5
									 members served
up to $3.33 per 1/4 hour*
H2023 US
Work Support (supported employment)-Group 6
									 members served
up to $2.98 per 1/4 hour*
T2015
Career Planning (Habilitation,
									 prevocational)
$61.13 per hour*
S5165
Home Accessibility Adaptations
Per invoice
S5165 CG
Home Accessibility Adaptations repairs
Per invoice
97755
Assistive Technology-Assessment
$ 15.15 per 1/4 hour*
T2035
Assistive Technology-Transmission (Utility
									 Services)
Up to $50.00 per month
A9279
Assistive Technology-Devices (Monitoring
									 feature/device, stand alone or integrated, any type, includes all accessories,
									 components and electronics, not otherwise classified)
Per invoice up to $6,296.40 per year*
S5150
Respite Services- 1/4 hour
$8.63 per 1/4 hour*
S5151
Respite Services- Per Diem
$287.35 per diem*
Modifiers Modifier
						  Description
CG Policy Criteria Applied
SC Medical Add On
HQ Group Setting
QC Remote Support-Monitor Only
GT Remote Support-Interactive Support
UN Two Members Served
UP Three Members Served
UQ Four Members Served
UR Five Members Served
US Six Members Served
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 III - Allowances for Services › Section 144-101-III-31 - Federally Qualified Health Center Services

Current through 2024-29, July 17, 2024
Procedure & Revenue Codes
Description
Unit of Service
Maximum Allowance
T1015
Clinic visit/encounter, all inclusive
Per visit
By report
0521
FQHC
T1015 HE
Clinic visit/encounter, all inclusive
Per visit
By report
0521
FQHC
T1015
Home visit/encounter, all inclusive
Per visit
By report
0522
FQHC
T1015
Visit to SNF (Part A*)
Per visit
By report
0524
FQHC
*A covered Part A stay means that Medicare A will
								pay the services as the primary carrier
T1015
Visit to SNF (Non-covered*)
Per visit
By report
0525
FQHC
*A non-covered stay means that Medicare A is not
								paying for the inpatient stay/services
T1015
Visit to Other Site
Per visit
By report
0528
FQHC
T1015
Ambulatory Clinic Visit
Per visit
By report
0529
FQHC
S9441
Asthma education, nonphysician provider, per
								session
Per visit
By report
0521
FQHC
G0108
Diabetes outpatient self-management training
								services, individual, per 30 minutes
Per 30 minutes
By report
0521
FQHC
G0109
Diabetes outpatient self-management training
								services, group session (2 or more) per 30 minutes
Per 30 minutes
By report
0521
FQHC
FQHCs are reimbursed for all Food and Drug
								Administration (FDA) approved pharmacotherapy for tobacco dependence
								treatment.
99406
Smoking and Tobacco Cessation Counseling;
								individual, intermediate
3-10 minutes
$8.67
0521
FQHC
99407
Smoking and Tobacco Cessation Counseling;
								individual, intensive
Greater than 10 minutes
$16.81
0521
FQHC
99411
[Tobacco Cessation] Preventive Medicine Counseling
								and/or risk factor reduction intervention(s) provided to individuals in a group
								setting (separate procedure), approximately 30 minutes
Per session
$11.54
0521
FQHC
99412
[Tobacco Cessation] Preventive Medicine Counseling
								and/or risk factor reduction intervention(s) provided to individuals in a group
								setting (separate procedure); approximately 60 minutes
Per session
$15.04
0521
FQHC
G0009
Administration of Pneumococcal Vaccine
1 unit
$5.00
0521
G0008
Administration of Influenza virus Vaccine
1 unit
$5.00
0521
FQHCs are reimbursed for all Food and Drug
								Adminsitration (FDA) approved Intrauterine Devices at the rate listed on the
								MaineCare UCR:
https://mainecare.maine.gov/
J1050
Injection, medroxyprogestrone acetate, 1 mg.
1 unit
By report
Modifiers
Description
GT
Via interactive audio and video telecommunication
								systems
HE
Behavioral health
SL
State supplied vaccine
UF
Services provided in the morning (6 a.m. to 11:59
								a.m.)
UG
Services provided in the afternoon (12 p.m. to 5:59
								p.m.)
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 III - Allowances for Services › Section 144-101-III-32 - Allowances for Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders

Current through 2024-29, July 17, 2024
Procedure Code
Modifier
Description
Unit of Service
Maximum allowance
T2017
HA
HOME SUPPORT (Habilitation, residential,
								waiver)-Family
1/4 hour
$6.33
T2017
HA TJ
HOME SUPPORT (Habilitation, residential, waiver)
								-Agency
1/4 hour
$6.33
T2016
HA
HOME SUPPORT (Habilitation, residential, waiver)
								-Family
Per diem
$265.83
T2016
HA TG
level of support
Per diem
$502.79
T2016
HATJ
HOME SUPPORT (Habilitation, residential, waiver)
								-Agency
Per diem
$353.91
S5150
HA
RESPITE
1/4 hour
$3.00
S5151
HA
RESPITE
Per diem
$90.00
S5165
HA
HOME ACCESSIBILITY ADAPTATIONS (Home Modifications)
Per itemized invoice
S5165
CG HA
Repairs
Per itemized invoice
V5274
HA
COMMUNICATORS (INCLUDING REPAIR AND MAINTENANCE),
								ASSISTIVE DEVICES
Per itemized invoice
G9007
HA HP
CONSULTATION-Psychiatric
1/4 hour
$63.75
G9007
HA AH
CONSULTATION-Psychological
1/4 hour
$19.80
G9007
HA GP
CONSULTATION-Physical Therapy
1/4 hour
$5.40
G9007
HA GN
CONSULTATION-Speech Therapy
1/4 hour
$5.40
G9007
HAGO
CONSULTATION-Occupational Therapy
1/4 hour
$5.40
G9007
HA
CONSULTATION-Recreational Therapy
1/4 hour
$5.40
G9007
HA HI
CONSULTATION-Behavioral
1/4 hour
$21.00
Modifiers -
TJ-
Agency Home
								Support
TG-
Increased Level of Support
HA-
Child
HP-
Psychiatric Consultation
AH-
Psychological Consultation
GP-
Physical Therapy
GN-
Speech Therapy
GO-
Occupational Therapy
HI-
Behavioral Consultation
CG-
Repairs for Home Modifications
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 III - Allowances for Services › Section 144-101-III-35 - Hearing Aids and Services (repealed and absorbed by Ch. II Section 60)

Current through 2024-29, July 17, 2024