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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.07 - LIMITS

Current through 2024-29, July 17, 2024
The following service limits apply to each member:
20.07-1
Assistive Technology
					 Services
- Each system or device will be reviewed based on medical
					 necessity, efficiency and whether it meets compatibility with safety needs.
					 Assistive Technology Services are limited to as described in the covered
					 service 20.05-1.
* The Assistive Technology Device and services described
						in 20.05-1(B) and (C) are subject to a combined limit of $6,000.00
						annually.
* The services described in 20.05-1(A), (D), (E) and (F)
						are subject to a combined limit of 32 units (8 hours) annually.
* The data transmission utility costs described in
						20.05-1(G) are limited to $50.00 per month.
20.07-2
Care Coordination
					 Services
-Care Coordination Services are limited to 400 units per year.
					 The Care Coordination provider may not offer any other services to the member
					 under this Section.
20.07-3
Communication Aids
- Communication Aids are limited to $6000.00 per
					 service year. Each system or device will be reviewed based on medical
					 necessity, efficiency and whether it meets compatibility with safety
					 needs.
20.07-4
Community
					 Support Services
-Community Support Services are limited to 128 units per
					 week, for an annual total of 6656 units per service year. The maximum weekly
					 allowance for Work Support Services is 128 units, for an annual total of 6656
					 units. When members use a combination of both services, there is a weekly limit
					 of 128 units per week and an annual limit of 6656 units on the total combined
					 expenditures for the services.
20.07-5
Consultation
					 Services
-Consultation Services are limited to 64 units per service year,
					 each type of Consultation Service.
20.07-6
Employment Specialist
					 Services
- Employment Specialist Services are limited to 72 units per
					 service year.
20.07-7
Home
					 Accessibility Adaptions
- Home Accessibility Adaptions are limited to
					 $3,000.00 per service year.
20.07-8
Home Support Services
- Home Support (1/4 hour) is limited to 64
					 units per day. Home Support (Remote Support) is limited to 64 units per
					 day.
20.07-9
Non-Traditional
					 Communication Assessment
- Non-Traditional Communication Assessment is
					 limited to 64 units per service year.
20.07-10
Non-Traditional Communication
					 Consultation
- Non-Traditional Communication Consultation is limited to
					 64 units per service year.
20.07-11
Occupational Therapy Maintenance
- Occupational Therapy Maintenance
					 is limited to 8 units per week up to 416 units per service year.
20.07-12
Personal Care Services
-
					 Personal Care Services are limited to 52 units per day.
20.07-13
Physical Therapy
					 Maintenance
- Physical Therapy Maintenance is limited to 8 units per week
					 up to 416 units per service year.
20.07-14
Specialized Medical Equipment
					 and Supplies
- Any item over $500.00 requires documentation from a
					 physician, an Occupational Therapist, Physical Therapist or Speech
					 Therapist.
20.07-15
Speech
					 Therapy Maintenance
- Speech Therapy Maintenance is limited to 8 units
					 per week up to 416 units per service year.
20.07-16
Work Support
					 Services
-Work Support Services are limited to 128 units per week up to
					 6656 units per service year. The maximum weekly allowance for Community Support
					 is 128 units, for an annual total of 6656 units. When members use a combination
					 of both services there is an annual limit of 6656 units on the total combined
					 expenditures for the services.
20.07-17
Section 20 Home and Community
					 Based Services for Adults with Other Related Conditions
may not be
					 provided in a residence where other Home and Community Based Waiver services
					 are provided. Exceptions to this limit will be considered on a case-by-case
					 basis by the Department. Consideration of this exception will be contingent on
					 the member's Care Plan ensuring that all identified services will be delivered
					 without compromising the quality of care, and on all aspects of the costs of
					 services being clearly delineated in order to demonstrate that there is not
					 blending of financial benefits between the members served.