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-102.06 - LIMITATIONS

A. Exclusive of Clinical Assessment and Reassessment, Services are limited to a combination of no more than eighteen (18) hours (72 units) per week. MaineCare will only cover one service at a time for each eligible member under this Section.

B. A member may not receive coverage for services under this Section if he or she is involved in acute hospital rehabilitation services.

C A member may not receive coverage for services under this Section if he or she is receiving intensive rehabilitative NF services, as defined in Section 102.02-8.

D. Services must not duplicate services delivered under any other Section of the MBM, including but not limited to: Section 97, Private Non-Medical Institution Services; Section 12, Consumer Directed Attendant Services; Section 22, Home and Community-Based Waiver Services for the Physically Disabled; Section 19, Home & Community Benefits for the Elderly and for Adults with Disabilities; Section 96, Private Duty Nursing & Personal Care Services; Section 68, Occupational Therapy Services; Section 85, Physical Therapy Services; Section 109, Speech and Hearing Services; Section 111,

Substance Abuse Treatment Services; Section 17, Community Support Services; Section 24, Day Habilitation Services for Persons with Mental Retardation; Section 26, Day Health Services; and Section 65, Behavioral Health Services.

E. MaineCare will only reimburse for initial clinical Assessment services (described in Sections 102.05-1 and 102.08-7(A)(1) up to eight (8) hours (32 units) of service, per member, per occurrence of acquired brain injury. MaineCare will reimburse Clinical Reassessment for up to eight (8) hours (32 units) per year.

F. MaineCare will reimburse for a covered service provided in an individual or a group session. A "group" must not exceed four (4) members per each licensed or certified clinician or other qualified staff person. When group services are provided, a brief notation must be made for each member in his or her medical record.