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-50 - ICF-MR Services › Appendix 144-101-II-A - SUPPLIES AND EQUIPMENT WHICH ARE PROVIDED AS PART OF THE ICF-MR REGULAR RATE OF REIMBURSEMENT

Current through 2024-29, July 17, 2024
The following supplies and equipment must be provided to
						a member by an ICF-MR as part of the facility's regular rate of reimbursement,
						when items are required by the member.
Facilities that serve a special group of disabled members
						are expected to furnish that equipment which is normally used in their care
						(e.g. children's wheelchairs) as a part of their reimbursement rate.
Neither the facility nor the supplier may bill for the
						following items:
1. Alcohol, swabs and
					 rubbing
2. Analgesics,
					 non-prescription including: aspirin: plain, buffered and coated, suppositories;
					 acetaminophen: tablets, liquids and suppositories.
3. Antacids, non-prescription including:
					 Aluminum/magnesium hydroxide (ex. Maalox); Aluminum/magnesium hydroxide with
					 simethicone (ex. Mylanta, Maalox Plus); Calcium carbonate tablets (ex. Tums);
					 Calcium carbonate/ magnesium hydroxide tablets (ex. Rolaids)
4. Alternating pressure pads, air mattresses,
					 "Egg Crate" mattresses, gel mattresses
5. Applicators
6. Bandages
7. Bandaids
8. Basins
9. Beds (standard hospital type, not therapy
					 beds)
10. Bed pans
11. Bed rails
12. Blood pressure equipment
13. Bottles (water)
14. Canes
15. Calcium supplements, non-prescription
					 (ex. Tums, Oscal)
16.
					 Catheters
17. Catheter trays
					 (disposable)
18. Chairs (standard
					 and geriatric)
19. Combs
20. Commodes
21. Corner chair
22. Cotton
23. Cough syrup and expectorants, all
					 non-prescription brands
24.
					 Crutches
25. Cushions (e.g.,
					 comfort rings)
26. Dietary
					 supplements
27.
					 Disinfectants
28. Douch trays
					 (disposable)
29.
					 Dressings
30. Enema
					 equipment
31. Enteral feeding,
					 supplies and equipment
32. Facility
					 deodorants
33. Gauze bandages
					 (sterile or non-sterile)
34.
					 General services such as administration of oxygen and related medications, hand
					 feeding, incontinency care, tray service, and enemas
35. Glucometers
36. Gloves (sterile and unsterile)
37. Gowns
38 Hemorrhoidal preparations
39. Ice bags
40. Incontinency supplies (full brief- all
					 sizes; bedpad; undergarment liners, disposable or reusable;
					 underpads)
41. Iron
					 supplements
42. Irrigation
					 trays
43. Laundry services,
					 personal (including supplies and equipment)
44. Laxatives, non-prescription including:
					 Stool softeners (ex. Docusate sodium liquid or capsule); Bulk: (ex. Psyllium);
					 Stimulants: (ex. Bisacodyl tablets and suppositories; docusate casanthranol,
					 liquid and/or capsule); Enemas: (ex. Saline, phosphate types-except Fleets);
					 oil retention; Misc.: milk of magnesia; glycerin suppositories; lactulose and
					 analogs (when used as a laxative); mineral oil.
45. Lotions (emollient)
46. Lubricants (skin, bath oil)
47. Mats
48. Mouth wash
49. Ointments and creams (available over the
					 counter), including petroleum jelly and hydrocortisone 0.5%
50. Ophthalmic lubricants: tears,
					 ointments
51. Oxygen, for emergency
					 and prn use only, including portable oxygen and equipment
52. Parenteral solutions, supplies and
					 equipment
53. Pillows
54. Pitchers (water)
55. Powders (medicated and baby)
56. Prone boards
57. Restraints (posey, thorasic chest
					 supports, wedge pillows, etc.)
58.
					 Sand and water tables
59. Sensory
					 stimulation materials
60. Shampoo,
					 regular; medicated; no tears baby shampoo
61. Sheepskin
62. Shower chairs
63. Soap: including hypoallergenic
64. Special dietary supplements
65. Specimen containers
66. Sterile I.V. or irrigation
					 solution
67. Stethoscopes
68. Sunscreen - SPF 30
69. Supplies necessary for treatment of
					 decubiti (non-prescription)
70.
					 Suture sets
71. Swabs, medicated or
					 unmedicated
72. Syringes and
					 needles
73. Tapes
74. Testing materials to be used by staff of
					 facility, not to include material normally included in psychometric
					 testing
75. Thermometers
76. Tissues
77. Toothbrushes
78. Toothpaste
79. Towels, washcloths
80. Tongue depressors
81. Traction equipment
82. Trapezes
83. Tub seats
84. Tubes (gavage, lavage, etc.)
85. Underpads
86. Urinals
87. Urinary drainage equipment and supplies
					 (disposable)
88. Velcro
					 strips
89. Vestibular
					 boards
90. Vitamins,
					 non-prescription, all brands
91.
					 Walkers
92. Wheelchairs - Standard:
					 Chairs with removable arms and leg rests; wheelchairs with elevators; pediatric
					 wheelchairs; "hemi" wheelchairs; reclining wheelchairs
93. Wipes, rectal medicated
94. Routine personal hygiene and grooming
					 items to include, but not be limited to items for shaving, shampooing, bathing,
					 nail clipping (unless specified as a covered service when performed by a
					 podiatrist as covered under the MaineCare Benefits Manual), haircutting or the
					 services of a barber when requested and paid for by the member.
95. Routine transportation of members or
					 laboratory specimens to hospital or doctor's offices