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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder
Subsection 144-101-II-21.07 - LIMITS

21.07-1 MaineCare Members can receive services under only one Home and Community Waiver Benefit at any one time.

21.07-2 Effective January 1, 2021, when the Member receives Community Support services in addition to Work Support-Group and/or Work Support-Individual services, the combined cost of Community Support, Work Support-Individual and Work Support-Group may not exceed $39,875.32 annually.

21.07-3 Home Accessibility Adaptations are limited to a ten thousand-dollar ($10,000.00) limit in a five (5) year period with an additional annual allowance up to three hundred dollars ($300.00) for repairs and replacement per year. Home Accessibility Adaptions that exceed five hundred dollars ($500) require documentation from a physician or other appropriate professional such as an OT, PT, or Speech Therapist, indicating that the purchase is appropriate to meet the Member's need.

21.07-4 Specialized Medical Equipment and Supplies are limited to only specialized medical equipment and supplies that cannot be obtained as a covered service under other sections of the MaineCare Benefits Manual.. Proof of attempts to obtain requested services under other MaineCare sections may be required for approval. These services are to be considered the property of the Member.

For purchases of Specialized Medical Equipment and Supplies costing more than five hundred dollars ($500), the Member must obtain documentation from a physician or other appropriate professional such as an occupational, physical, or speech therapist assuring that the purchase is appropriate to meet the Member's need and is medically necessary.

21.07-5 Communication Aids costing more than five hundred dollars ($500), the Member must obtain documentation from a licensed speech-language pathologist, Licensed Audiologist or a Certified Assistive Technology Professional (ATP) assuring that the purchase is appropriate to meet the Member's need and assuring the medical necessity of the devices or services. Only Communication Aids that cannot be obtained as a covered service under other sections of the MaineCare Benefits Manual will be reimbursed under this Section.

21.07-6 Consultation Services are limited to those providers not already reimbursed for consultation as part of another service. Personnel who provide services under targeted case management may not be reimbursed for Consultation Services. Consultation is limited to sixty-six (66) units or sixteen and a half (16.5) hours annually, per type of consultation (Occupational Therapy, Physical Therapy, Speech, Behavioral and Psychological).

21.07-7 Non-traditional Communication Consultation is limited to sixty (60) hours annually.

21.07-8 Crisis Intervention Services that have not been included on the Person-Centered Service Plan are limited to a period not to exceed two weeks and must be authorized by the DHHS or its Authorized Entity. Crisis Intervention Services may not extend past two (2) weeks without a recommendation from the Member's Person-Centered Service Team and additional approval from DHHS.

21.07-9 Crisis Assessment Services are limited to one (1) assessment in a three-year (3) period, with a maximum allowance of $2,250.00, and includes all related follow-up activities.

21.07-10 Occupational Therapy (Maintenance) provided by an Occupational Therapist, Registered, Licensed (OTR/L) is limited to forty-eight (48) quarter hour units per year. Occupational Therapy (Maintenance) provided by an Occupational Therapist Assistant/Licensed (OTA/L) is limited to forty (40) quarter hour units per year. When a OTA/L is providing Occupational Therapy (Maintenance), it must be under the supervision of an OTR.

21.07-11 Enrollment in High School A Member may not receive Community Support while enrolled in high school.

21.07-12 Place of Employment A Member may not receive Community Support or Home Support at his or her place of employment.

21.07-13 Family-Centered Support Providers No additional Family-Centered Support providers will be approved and enrolled after 12/20/2007.

21.07-14 Nursing Facility or Hospital If a Member enters a nursing facility or a hospital, payment under Section 21 will be temporarily suspended. If the Member remains in the nursing facility or hospital for more than thirty (30) consecutive days, enrollment in this waiver will be terminated unless there is a written request to DHHS to continue holding the funded opening.

After six (6) continuous months in a nursing facility or hospital, if the Member does not resume services, the Member will be terminated from the waiver.

21.07-15 Work Support-Individual services are limited to one DSP per Member at a time.

21.07-16 Home Support- Agency Per Diem as of December 24, 2012, Home Support- Agency Per Diem placements will only be approved at provider controlled homes where a minimum of two (2) Members reside.

21.07-17 Home Support Quarter Hour may not exceed three hundred and thirty-six (336) quarter hour units or eighty-four (84) hours a week. Units of service that were not provided to a Member in any week cannot be carried over into subsequent weeks.

21.07-18 Out of State Services Authorizations for services to be provided out of state will not exceed sixty (60) days of service within a given fiscal year and not exceed sixty (60) days within any six (6) month period except as provided in 42 C.F.R. § 431.52(b).

21.07-19 Annual MaineCare Expenditures for services under this waiver for an individual Member are limited to two hundred percent (200%) of the state-wide average annual cost of care for an individual in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), as determined by DHHS.

21.07-20 Assistive Technology Services are not covered under this rule if they are available under another MaineCare rule.

The components above are subject to the following limits:

21.07-21 Career Planning is limited to sixty (60) hours to be delivered in a six-month period. No two six-month periods may be provided consecutively.

Career planning furnished under the waiver may not include services available under a program funded under section 110 of the Rehabilitation Act of 1973 or section 602(16) and (17) of the Individuals with Disabilities Education Act, 20 U.S.C. §§ 1401(16), (17).

21.07-22 Employment Specialist Services are provided on an intermittent basis with a maximum of ten hours each month.

21.07-23 Home Support-Remote Support is limited to forty-eight (48) units (12 hours) per day. This can be in addition to Home Support-Quarter Hour, as long as this is not duplicative.