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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.06 - NON-COVERED 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:
21.06.1
Duplicative Services
A
					 Member receiving services under this Section
					 21, may not receive duplicative
					 MaineCare services at the same time under any other sections of the
MaineCare Benefits Manual
, including: Section 2, Adult Family
					 Care Services; Section
					 18, Home and Community-Based
					 Services for Adults with Brain Injury; Section
					 19, Home and Community Benefits
					 for the Elderly and for Adults with Disabilities; Section
					 20, Home and Community-Based
					 Services for Adults with Other Related Conditions; Section
					 28, Rehabilitative and Community
					 Support Services for Children with Cognitive Impairments and Functional
					 Limitations; Section
					 29, Support Services for Adults
					 with Intellectual Disabilities or Autism Spectrum Disorder; Section
					 45, Hospital Services; Section
					 46, Psychiatric Facility Services;
					 Section
					 50, I CF/IID Services; Section
					 67, Nursing Facility Services, and
					 Section
					 97, Private Non-Medical
					 Institution Services, when the Member is receiving personal care
					 services.
21.06-2 Services not
					 identified by the Person-Centered Service Plan;
21.06-3 Services to any MaineCare Member who
					 receives services under any other federally approved MaineCare Home and
					 Community based waiver program;
21.06-4 Services to any Member who is a
					 nursing facility resident, state psychiatric hospital or ICF/IID
					 resident;
21.06-5 Services that are
					 reimbursable under any other sections of the
MaineCare Benefits
					 Manual
;
21.06-6 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;
21.06-7
					 Room and board is not reimbursed by MaineCare. 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. Board does not include the provision of a meal or
					 snacks at an adult day health or similar facility outside the Member's home.
					 Board also does not include the delivery of a single meal to a Member at
					 his/her own home through a meals-on-wheels service;
21.06-8 Services provided directly or
					 indirectly by the legal guardian will not be reimbursed unless the legal
					 guardian is the Member's parent, sibling or other biological family member.
					 This rule will not be avoided by adult adoption. Persons appointed by a probate
					 court as legal guardian prior to and up to December 30, 2007, who are not
					 biological family, and who are directly or indirectly reimbursed for services,
					 may continue to receive reimbursement under this Section. Relatives who provide
					 waiver services must meet the same standards as providers who are unrelated to
					 the Member;
21.06-9 Work
					 Support-Individual, Work Support-Group or Employment Specialist Services when
					 the Member is not engaged in employment; and
21.06-10 Specialized Medical Equipment and
					 Supplies, Communication Aids, or Home Accessibility Adaptations unless the
					 service has been determined non-reimbursable under Medical Supplies and Durable
					 Equipment, Section
					 60 or other sections of the
MaineCare Benefits Manual
.