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-96 - Private Duty Nursing and Personal Care Services › Subsection 144-101-II-96.05 - NON-COVERED SERVICES

Current through 2024-29, July 17, 2024
The following services are not reimbursable under this
						Section:
A. Services for which the
					 cost exceeds the limits described in this Section, except as described in
					 96.03(A);
B. Psychiatric nursing
					 services, except as described under Section
					 96.04(A);
C. Those services that can be reasonably
					 obtained by the Member outside his/her place of residence;
D. Unless qualified for the "special
					 circumstances nursing" (see Section
					 96.04(B),
					 nursing services when provided by the Member's husband or wife, natural or
					 adoptive parent, child, or sibling, stepparent, stepchild, stepbrother or
					 stepsister, father in law, mother in law, son in law, daughter in law, brother
					 in law, sister in law, grandparent or grandchild, spouse of grandparent or
					 grandchild or any person sharing a common abode as part of a single family
					 unit;
E. Personal care services
					 provided by a spouse of the Member, the parents or stepparents of a minor
					 child, or a legally responsible relative;
F. Homemaker and chore services not directly
					 related to medical necessity. Homemaker and chore services are covered in this
					 Section only as authorized by the ASA in the plan of care when
					 required;
G. Services in an
					 ICF-IID, nursing facility or hospital;
H. Services to Members receiving any Home and
					 Community Benefits for the Elderly, or Adults with Disabilities (nursing and
					 personal care services are covered under these waiver benefits);
I. Escorting Members outside of the home,
					 except as described in Section 96.01-3 or
					 96.04(C);
J. Custodial care or respite care;
K. Except for those services delivered under
					 Level IX, personal care services delivered in an Adult Family Care Home setting
					 or other licensed Assisted Living Facility that is reimbursed for providing
					 personal care services It is the responsibility of the AFCH or assisted living
					 provider to deliver personal care services;
L. Personal care services may not be provided
					 under this Section to Members receiving Section
					 18, "Home and Community-Based
					 Services for Adults with Brain Injury"; Section
					 19, "Home and Community-Based
					 Services for the Elderly and Adults with Disabilities"; Section
					 20, "Home and Community-Based
					 Services for Adults with Other Related Conditions"; Section
					 21, "Home and Community Benefits
					 for Persons with Intellectual Disabilities or Autism Spectrum Disorder"; or
					 Section
					 29, "Support Services for Adults
					 with Intellectual Disabilities or Autism Spectrum Disorders." Personal care
					 services are covered services under these Waivers. Waiver Members may only
					 receive nursing services under this Section;
M. Supervisory visits made for the purpose of
					 supervising home health aides, certified nursing assistants or personal care
					 assistants;
N. Services which are
					 not approved by the plan of care; or
O. Services in excess of 40 hours per week,
					 provided by an individual PSS, home health aide or certified nursing assistant,
					 for an individual Member.