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-102 - Rehabilitative Services › Subsection 144-101-II-102.05 - COVERED SERVICES

Current through 2024-29, July 17, 2024
A covered service is a service for which payment to a
						provider is permitted under this Section of the MaineCare Benefits Manual. The
						types of rehabilitative services that are covered for eligible individuals are
						the following:
102.05-1
Clinical
					 Assessment Services (96150, 96151)
A qualified neuropsychologist (defined in Section
						102.08-5(B)) and/or a licensed physician who is Board certified, or otherwise
						Board eligible, in either physical medicine and rehabilitation or neurology,
						must conduct and supervise a Clinical Assessment, face-to-face with the member,
						in collaboration with the interdisciplinary team, as part of the admission
						process. The findings of the Clinical Assessment form the basis for the
						specific rehabilitation goals and describe the types and frequencies of each
						service and the expected outcomes and timeframes. The Clinical Assessment must
						indicate the degree of functional impairment, assess the member's potential for
						physical and/or behavioral and/or cognitive rehabilitation, include the BIAT
						and the health and safety assessment and meet the requirements of Section
						102.08-7(A)(1). Reimbursement for brain injury Clinical Assessment services
						must not exceed eight (8) hours (32 units) of service, per member.
MaineCare will reimburse for the Clinical Assessment to
						confirm the diagnosis of brain injury, even if the member is not found eligible
						for services under this Section. These members should be provided with other
						service recommendations, as appropriate, to address needs identified by the
						Clinical Assessment. The provider will also conduct a Reassessment once every
						six months. All Clinical Assessments will be completed with thirty (30) days of
						initiation of services. If the Clinical Assessment cannot be completed within
						this time frame, case record documentation will reflect the reason and plans
						for completion.
102.05-2
Intensive Integrated Neurorehabilitation (97532)
Integrated treatment includes the rehabilitation of
						physical, cognitive, psychological, and behavioral issues including restorative
						and compensatory approaches. These treatments are provided on a 1:1 basis by
						licensed/certified medical/rehabilitative personnel within a coordinated team
						process. Care coordination is an integral component of this process.
102.05-3
Neuro-behavioral
					 Rehabilitation (96152, 96153, 96154)
Integrated treatment includes interventions for
						biopsychosocial factors associated with brain injury: disruptive and
						non-compliant behaviors, cognitive unawareness, health and physically related
						risk-taking behaviors, and emotional adjustment to brain injury. These
						treatments are provided by licensed/certified medical/rehabilitative personnel
						and their extenders within a coordinated team process. Care coordination is
						included.
102.05-4
Self Care/Home Management Reintegration (97535, 97535-HQ)
Integrated treatment includes compensatory interventions
						and treatment focused on functional improvement and reinforcement of self care
						and home management. These treatments are provided on a 1:1 and group basis by
						licensed/certified medical/rehabilitative personnel and their extenders within
						a coordinated team process. Care coordination is included. Group services are
						coded with
HQ
.
102.05-5
Community/Work Reintegration
					 (97537, 97537-HQ)
Integrated treatment includes compensatory interventions
						and treatment focused on functional improvement and reinforcement of community
						and work reintegration. These treatments are provided on a 1:1 and group basis
						by licensed/certified medical/rehabilitative personnel and their extenders
						within a coordinated team process. Care coordination is included. Group
						services are coded with
HQ
.