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-26 - Day Health Services
Subsection 144-101-II-26.08 - REIMBURSEMENT

A. The provider's usual and customary charge; or

B. The amount listed in the "Allowances for Day Health Service", Chapter III.

In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from any other resources that are available for payment prior to billing MaineCare.

Reimbursement for services provided by licensed professionals listed in Section 26.07-1 on a consulting basis is included in the day health service reimbursement rate. The consulting provider must not bill separately for these services except for physical therapy, occupational therapy services, and speech therapy that are provided on an individual basis, rather than in a group, according to physician orders and a plan of care. These services may be billed in accordance with Chapter II, Section 68, "Occupational Therapy Services"; Chapter II, Section 85, "Physical Therapy Services"; or Chapter II, Section 109, "Speech-Language Pathology Services", of the MaineCare Benefits Manual.

Pursuant to P.L. 2017, ch. 460, Part B, Sec. B-2: Effective July 1, 2019, payment rates attributable to wages and salaries for personal care and related services will be increased annually by an inflation adjustment cost-of-living percentage in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index, Medical care services (professional services, nursing home and adult day care services) from the prior December. These cost of living increases shall continue annually until the Department has completed a rate study for adult family care services, adult day services or homemaker services and the rates in the rate study have been implemented.

Day health services provided to members of the Department's Home and Community Benefits for the Elderly and for Adults with Disabilities must be reimbursed under the relevant rule, and not under this Section.