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-12 - Consumer Directed Attendant Services › Subsection 144-101-II-12.11 - BILLING INSTRUCTIONS

Current through 2024-29, July 17, 2024
Providers must bill in accordance with the Department's
						billing instructions for the CMS 1500 that providers receive in their
						enrollment packages.
ADL = Activities of Daily Living
Activity
Definitions
Time Estimates
Considerations
Bed Mobility
How person moves to and from lying position,
								  turns side to side and positions body while in bed.
5 - 10 minutes
Positioning supports, cognition, pain, disability
								  level.
Transfer
How person moves between surfaces - to/from: bed,
								  chair, wheelchair, standing position (EXCLUDE to/from bath/toilet).
5 - 10 minutes
up to 15 minutes
Use of slide board, gait belt, swivel aid,
								  supervision needed, positioning after transfer mechanical lift transfer.
Locomotion
How person moves between locations in his/her
								  room and other areas on same floor. If in wheelchair, self-sufficiency once in
								  chair.
5 - 15 minutes
(Document time and number of times done during
								  Plan of Care)
Disability level, type of aids used, pain.
Dressing & Undressing
How person puts on, fastens and takes off all
								  items of street clothing, including donning/removing prosthesis.
20 - 45 minutes
Supervision, disability, cognition, pain, type of
								  clothing, type of prosthesis.
Eating
How person eats and drinks (regardless of
								  skill)
5 minutes
Set up, cut food and place utensils.
30 minutes
Individual is fed.
30 minutes
Supervision of activity due to swallowing,
								  chewing, cognition issues.
Toilet Use
How person uses the toilet room (or commode,
								  bedpan, urinal); transfers on/off toilet, cleanses, changes pad, manages ostomy
								  or catheter and adjusts clothes.
5 -15 minutes/use
Bowel, bladder program ostomy regimen, catheter
								  regimen.
Personal Hygiene
How person maintains personal hygiene. (EXCLUDE
								  baths and showers)
20 min/day
Disability level, pain, cognition, adaptive
								  equipment.
Washing face, hands, perineum, combing hair,
								  shaving and brushing teeth
Shampoo (only if done separately)
Nail Care
15 min up to 3 times/week
20 min/week
Walking
How person walks for exercise only How person
								  walks around own room How person walks within home How person walks
								  outside
Document time and number of times in plan of
								  care, and level of assistance needed.
Disability, pain, mode of ambulation (cane),
								  prosthesis needed for walking.
Bathing
How person takes full-body bath/shower, sponge
								  bath (EXCLUDE washing of back, hair), and transfers in/out of tub/shower
15 - 30 minutes
If shower used and shampoo done, then consider as
								  part of activity.
These allowances reflect the time normally
								  allowed to accomplish the listed tasks. The ASA will use these allowances when
								  authorizing a member's authorized plan of care. If these times are not
								  sufficient when considered in light of a member's unique circumstances as
								  identified by the ASA, the ASA may make an adjustment as long as the authorized
								  hours do not exceed limits established for member's level of care.
Time authorized has to reflect the possibility of
								  concurrent performance of activities, ex: while wash cycle running, dishes may
								  be washed, floor vacuumed, bathroom cleaned, and other simultaneous
								  activities.