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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.06 - LIMITS

Current through 2024-29, July 17, 2024
A.  Except as otherwise provided in this
					 Section, effective April 1, 2020, the program cap established by the Department
					 is $6,565. 00 per member per month.
B.
					  Skills Training Services shall not exceed 14. 25 hours per annual
					 eligibility period including the hours needed for initial instruction. These
					 costs will not be included as part of the member's monthly program cap.
C.  FMS is not included as part of
					 the monthly program cap.
D. 
					 Environmental Modifications may not exceed $3,000 per annual eligibility period
					 per member. These costs will not be included as part of the member's monthly
					 program cap.
E.  Assistive
					 Technology Devices and Services may not exceed $1,000 per member per annual
					 eligibility period. These costs are excluded from the member's monthly program
					 cap noted above.
F.  Assistive
					 Technology-Transmission: These services may not exceed $600 per member per
					 annual eligibility period. These costs are excluded from the member's monthly
					 program cap noted above.
G. 
					 Assistive Technology- Remote Monitoring: These services may not exceed $6,000
					 per member per annual eligibility period. These costs are excluded from the
					 member's monthly program cap noted above.
H.
					  Respite Services shall not exceed the allowed maximum, which is
					 based on the cost of thirty (30) days of Nursing Facility Services at the rate
					 as established in Chapter III, Section
					 19 (Respite Care Services, not in
					 the home), per member per annual eligibility period. These costs are included
					 as part of the member's monthly program cap.
I.
					  Home Delivered Meals has a limit of one meal per member, per day
					 up to seven days per week. The cost of this service shall be included in the
					 monthly program cap for the member.
J.
					  Living Well for Better Health: The program has a lifetime limit;
					 a member may attend this service up to three (3) times but no more than once
					 per calendar year. The cost of this service shall be included in the monthly
					 program cap for the member.
K. 
					 Matter of Balance (Falls Prevention): The program has a lifetime limit; a
					 member may participate in this program up to three (3) times but no more than
					 once per calendar year. The cost of this service shall be included in the
					 monthly program cap for the member.
L.
					  An individual who receives Attendant or Personal Care Services as
					 a member under this Section or other MaineCare or State-funded long-term care
					 programs may not be reimbursed as an Attendant or Personal Support Specialist.
M.  Attendant or Personal Care
					 Services: Delivery of these services to an individual member (or household) may
					 not exceed forty (40) hours per week from one individual staff member.
A member who is at risk of institutionalization may seek
						an exception to this limit. The criteria the Department shall consider in
						evaluating the request include:
1. 
					 Availability of workers in the member's area;
2.
					  Number of hours needed above the cap;
3.  Whether the member's condition is unique
					 as compared to other Section
					 19 members;
4.  The length of time for which the
					 exception is requested; and
5. 
					 The agency's or member's efforts to find other workers.
The Department's decision shall be in writing and shall
						be provided to the Member.