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-29 - Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-29.07 - LIMITS

Current through 2024-29, July 17, 2024
29.07-1 MaineCare members can receive
					 services under only one Home and Community Waiver Benefit at any one
					 time.
29.07-2 The combined annual
					 limit for members who receive Home Support (Remote or 1/4 hour), Community
					 Support, or Shared Living, is fifty two thousand, four hundred and twenty five
					 dollars ($52,425.00). This cap will be retroactive to July 1, 2017.
29.07-3 Employment Specialist Services are
					 provided on an intermittent basis with a maximum of ten (10) hours (forty (40)
					 quarter hour units) each month.
29.07-4 Home Accessibility Adaptations are
					 limited to tenthous and dollars ($10,000) in a five(5) year period with an
					 additional annual allowance up to three hundred dollars ($300) for repairs and
					 replacement per year. General household repairs are not included in this
					 service. All items in excess of five hundred ($500) dollars require
					 documentation from physician or other appropriate professional such as OT, PT
					 or Speech therapist that purchase is appropriate to meet the member's need.
					 Medically necessary home modifications that cannot be obtained as a covered
					 service under any other MaineCare benefit can be reimbursed under this
					 section.
29.07-5 A provider may
					 only be reimbursed for providing transportation services when the cost of
					 transportation is not a component of a rate paid for another service.
29.07-6 Respite Services are limited to one
					 thousand one hundred dollars ($1100.00) per year. This respite cap will be
					 effective retroactive to July 1, 2017. Additionally, the quarter hour (1/4)
					 billing for Respite shall not exceed the per diem limit of (Ninety dollars
					 ($90.00) for each date of service. Reimbursement for Respite is a quarter (1/4)
					 hour billing code. After thirty-three (33) quarter hour units of consecutive
					 Respite Services, the provider must bill using the per diem billing code.
The quarter hour (1/4) Respite amount billed any single
						day cannot exceed the Respite per diem rate of Ninety ($90.00) dollars.
29.07-7 Services reimbursed under
					 this section are not available to members who reside in an ICF/IID, nursing
					 facility or are inpatients of a psychiatric hospital or hospital.
29.07-8
Duplicative Services.
A
					 member may not receive services that are comparable or duplicative under
					 another Section of the
MaineCare Benefits Manual
at the same
					 time as services provided under this waiver benefit. Such comparable or
					 duplicative services include, but are not limited to services covered under the
MaineCare Benefits Manual
, 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
					 21, Home and Community Benefits
					 for Person with Intellectual Disabilities or Autism Spectrum Disorder; Section
					 28, Rehabilitative and Community Support Services for Children with Cognitive
					 Impairments and Functional Limitations; 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.
29.07-9 A member may not receive Community
					 Support while enrolled in high school. A member may not receive Community
					 Support at his or her place of employment.
29.07-10 A member may not receive Employment
					 Specialist Services while enrolled in high school.
29.07-11 Work Support Services are limited to
					 one Direct Support Professional per member at a time.
29.07-12 The total amount of Services
					 authorized may not exceed 50% of the state-wide average annual cost of care for
					 an individual in an Intermediate Care Facility for Individuals with
					 Intellectual Disabilities (ICF/IID), as determined by the Department.
29.07-13 If a current waiver recipient enters
					 a nursing facility or a hospital, payment under the waiver will be temporarily
					 suspended. If the waiver recipient remains in the nursing facility or hospital
					 for more than thirty (30) consecutive days, enrollment in this waiver will be
					 terminated unless there is a written request to the Department to continue
					 holding the funded opening.
29.07-14 Assistive Technology services are
					 not covered under this rule if they are available under another MaineCare rule.
Assistive Technology services are subject to the
						following limits:
A. Assistive
					 Technology-Assessment is subject to a combined limit of 32 units (8 hours) per
					 year.
B. Assistive
					 Technology-Devices, including the selecting, fitting, customizing, adapting,
					 applying, maintaining, repairing or replacing of assistive technology devices,
					 is subject to a combined limit of $6,000 per year.
C. Assistive Technology-Transmission (Utility
					 Services) is subject to a combined limit of $50 per month.