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-17 - Community Support Services › Subsection 144-101-II-17.05 - LIMITATIONS

Current through 2024-29, July 17, 2024
17.05-1
Reimbursement
. MaineCare
					 will reimburse only for covered services provided by agencies and individuals
					 pursuant to Section 17.07-2.
17.05-2
Multiple Provider
. Only
					 a single Community Support Provider may be reimbursed at the same time for
					 services to any one member under this Section for Community Integration
					 Services, Community Rehabilitation Services, or Assertive Community Treatment.
					 Other Community Support Services are reimbursable under this Section to more
					 than one Community Support Provider at a time. Requests for a waiver of the
					 limitation on multiple providers may be approved by DHHS or an Authorized
					 Entity, upon request and in accordance with Section 17.09-2(C).
Every Service under this Section must have an ISP as
						defined in 17.01-12. Coordination between all Section
						17 providers is required and must
						be documented in the ISP. The Community Support Provider who delivers 17.04-1
						(Community Integration), 17.04-2 (Community Rehabilitation Services), or
						17.04-3 (Assertive Community Treatment-ACT) services must develop an Individual
						Support Plan (ISP) pursuant to 17.04-1(E). If a member receives one of these
						four (4) services as well as 17.04-4 (Daily Living Support), 17.04-5 (Skills
						Development), 17.04-6 (Day Support), or 17.04-7 (Specialized Group) services,
						provided by the same agency, each service must also be added to the member's
						ISP developed pursuant to 17.04-1(E). If 17.04-4 (Daily Living Support),
						17.04-5 (Skills Development), 17.04-6 (Day Support), or 17.04-7 (Specialized
						Group) services are provided by a different Community Support Provider, the
						provider of the additional service is responsible for ensuring that the service
						is authorized, integrated and added in writing into the ISP developed by the
						Community Support Provider delivering 17.04-1, 17.04-2, 17.04-3
						services.
17.05-3
Concurrent Provision of Services
. The following chart reflects
					 covered services that may, and may not, be concurrently provided to a member:
A. Type of Service
B. Additional Services that May be Provided
								  Concurrently with the Service Listed in Column A
C. Services that may not be Provided
								  Concurrently with the Service Listed in Column A
Community Integration Services
1. Daily Living Support Services
or
Skills Development Services
or
Day Supports Services; and
2. Interpreter Services
1. Assertive Community Treatment
2. Community Rehabilitation Services
3. Section
								  92, Behavioral Health Home
4. Section
								  13, Targeted Case
								  Management
Community Rehabilitation Services
1. Day Supports Services; and
2. Interpreter Services
1. Community Integration Services
2. Assertive Community
Treatment 3. Daily Living Support
								  Services
4. Skills Development Services
Assertive Community Treatment
1. Daily Living Support Services or Skills
								  Development Services or Day Supports Services; and
2. Interpreter Services
1. Community Integration Services
2. Community Rehabilitation Services
Daily Living Support Services
1. Community Integration Services
2. Day Support Services
3. Assertive Community Treatment
4. Interpreter Services
1. Skills Development Services
Skills Development Services
1. Community Integration Services
2. Day Supports Services
3. Assertive Community Treatment
4. Interpreter Services
1. Daily Living Supports
Requests to provide concurrent services, such as any two
						services listed in Column B, Number 1 within each subcategory of the chart, to
						assist in a member's transition from one service to another, may be requested
						from DHHS or an Authorized Entity in accordance with
						17.09-2(C). Services provided
						through Section 17, Community Support Services may not be provided concurrently
						with Clubhouse or Specialized Group services provided via Section
						65, Behavioral Health
						Services.
17.05-4
Location
. Except as may be expressly provided in Section
					 17.04 or by federal
					 or state statute or regulation, covered services may be provided in any
					 community location.
17.05-5
Private Non-Medical Institutions
. Community Support Services
					 specified in Sections 17.04-2 and 17.04-3 cannot be provided in a Private
					 Non-Medical Institution, as defined in the
MaineCare Benefits
					 Manual
Chapters II & III Section
					 97, without written authorization
					 from DHHS or an-Authorized Entity in accordance with Section 17-09-2(C). In
					 order to avoid duplication of services, providers furnishing services under
					 Section 17.04-3 as part of treatment in a Private Non-Medical Institution must
					 coordinate and not duplicate services with providers of services outside the
					 residential setting, including but not limited to services provided in
MaineCare Benefits Manual
, Chapter II, Section
					 13 and 97.
17.05-6
Utilization Review
. DHHS
					 or an - Authorized Entity - reserves the right to Review continuation of any
					 covered services as described in this Section, applying the standards
					 established by this Section for eligibility and for continuation of a
					 service.
17.05-7
Exclusivity
					 of Billing
. If a service may be billed under either this Section or
					 Section
					 65, a Community Support Provider
					 may bill the service under only one of those sections for a single
					 member.
17.05-8
Day Support
					 Services
. Services previously billed under this section known as or
					 equivalent to "clubhouse" services, are defined and covered in Section
					 65 of the
MaineCare
					 Benefits Manual
as "Mental Health Psychosocial Clubhouse Services.
					 "Services provided under this policy consistent with the model of Psychosocial
					 Clubhouse Services are considered duplicative with services offered via Section
					 65, and are not covered under this
					 policy.