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-65 - Behavioral Health Service › Subsection 144-101-II-65.06 - NON-COVERED SERVICES

Current through 2024-29, July 17, 2024
Please refer to the
MaineCare Benefits
						Manual
, Chapter I, Section 1, "General Administrative Policies and
						Procedures", for a general listing of non-covered services including academic,
						vocational, socialization or recreational services and custodial services and
						associated definitions that are applicable to all Sections of the
MaineCare Benefits Manual
.
Additional non-covered services related to the delivery
						of mental health services are as follows:
65.06-1 Homemaking or Individual Convenience
					 Services: Any services or components of services of which the basic nature is
					 to maintain or supplement the housekeeping, homemaking or basic services for
					 the convenience of the member are not reimbursable under this policy. These
					 non-covered services include, but are not limited to, housekeeping, shopping,
					 Child day care, or respite and laundry service.
65.06-2
Transportation Services
:
					 Costs related to transportation services are built into the rates for all
					 services by allocation of non-personnel costs. Therefore, separate billings to
					 the MaineCare Program for travel time are not reimbursable.
65.06-3
Case Management
					 Services
: Any services, or components of services of which the basic
					 nature is to provide case management services are not reimbursable under these
					 Behavioral Health Services rules unless otherwise indicated. Please refer to
					 Chapter II, Section
					 13, "Targeted Case Management
					 Services", Chapter II, Section
					 17, "Community Support Services",
					 Chapter II, Section
					 92, "Behavioral Health Home
					 Services, and Chapter II, Section
					 93, "Opioid Health Home Services"
					 of the
MaineCare Benefits Manual
for a description of the
					 coverage of such services.
65.06-4
Adult Community Support/Adult Day Treatment Services
: Any
					 services, or components of services of which the basic nature is to provide
					 Adult Community Support Services, or Adult Day Treatment Services are not
					 reimbursable under this Section. Please refer to Chapter II, Section
					 17, "Community Support Services",
					 of the
MaineCare Benefits Manual
for a description of the
					 coverage of such services.
65.06-5
Financial Services
: Any services, or components of services of
					 which the basic nature is to provide economic services to the member, such as
					 financial or credit counseling are not covered under this Section.
65.06-6
Driver Education and Evaluation
					 Program (DEEP) Evaluations
: Any program, services or components of
					 services of which the basic nature is to provide DEEP evaluations are not
					 reimbursable under this Section.
65.06-7
Comparable or Duplicative
					 Services
: Services as defined under this Section are not covered if the
					 member is receiving comparable or duplicative services under this or another
					 Section of the
MaineCare Benefits Manual
.
1. Any Services provided as a Covered Service
					 under Section
					 65 are not covered and are not
					 reimbursable if the member is receiving another service under Section
					 65, except as set forth in the
					 specific Covered Services and as follows:
a.
					 Such concurrent services require Prior Authorization for a specified duration
					 and amount by DHHS or an Authorized Entity, and
b. Such exceptions are documented in the
					 member's ITP, and
c. Concurrent
					 services are consistent with the provisions in the MaineCare services described
					 in this Section and other
MaineCare Benefits Manual
Sections,
					 and
d. There is a clear, documented
					 clinical justification as to why concurrent treatment under this service is
					 needed, as follows:
i. During the course of
					 provision of a service the Clinician uncovers an issue requiring referral to
					 specialized treatment (e.g., trauma, sexual abuse issue, substance use),
					 or
ii. The service is necessary for
					 a successful transition of the member to a different level of care.