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-2 - Adult Family Care Services
Subsection 144-101-II-2.05 - LIMITATIONS

2.05-1 Duplication of services is not allowed. It is the responsibility of the AFC services provider to coordinate services with other "in-home" services to address the full range of a member's needs. Other MaineCare-covered services must not duplicate AFC covered services. For example, if a member receives Section 96, "Private Duty Nursing and Personal Care Services"; or Section 40, "Home Health Services"; or Section 19, "Home and Community-Based Benefits for the Elderly and Adults with Disabilities", or Section 43, "Hospice Services", all personal care services shall be delivered by the AFC services provider and not by a Certified Nursing Assistant (CNA), Home Health Aide (HHA), Personal Care Attendant (PCA) or Personal Support Specialist (PSS) as otherwise allowed in these Sections.

2.05-2 Private Duty Nursing Services and Personal Care Services are subject to financial "caps" as described in Section 96, "Private Duty Nursing and Personal Care Services". For members who receive Private Duty Nursing services, the cost of AFC services and Private Duty Nursing services combined must not exceed the member's approved Private Duty Nursing and Personal Care Services "cap." It is the responsibility of the Private Duty Nursing provider to monitor the cost of services and stay within the "cap." The increased reimbursement provided effective August 1, 2018 attributable to wages and salaries for personal care and related services, which shall be increased annually by an inflation adjustment pursuant to Ch. III, Sec. 2, shall not be counted towards the caps described herein.

2.05-3 MaineCare Waiver Services - A member receiving AFC services may receive services under a MaineCare Waiver program such as (Section 19, "Waiver Services for the Elderly and for Adults with Disabilities"; Section 22, "Waiver Services for the Physically Disabled").

However, the cost of the MaineCare-covered AFC services shall be included within the established waiver financial "cap." The Department's designated agency responsible for administering the member's waiver services must include the cost of MaineCare-covered AFC services within the member's "cap." The increased reimbursement provided effective August 1, 2018 attributable to wages and salaries for personal care and related services, which shall be increased annually by an inflation adjustment pursuant to Ch. III, Sec. 2, shall not be counted towards the caps described herein.