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-40 - Home Health Services
Subsection 144-101-II-40.06 - LIMITATIONS
Current through 2024-38, September 18, 2024
Services delivered under this Section shall not duplicate any other services delivered to the member. Duplication includes, but is not limited to:
A. Home health aide services shall not be reimbursed for members who are receiving services under Section 2, Adult Family Care Services, or Section 12, Consumer Directed Attendant Care Services, or Section 18, Home and Community-Based Services for Adults with Brain Injury, or Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities, or Section 20, Home and Community-Based Services for Adults with Other Related Services, or Section 21, Home and Community-Based Waiver Services for -Members with Intellectual Disabilities or Autistic Disorder -- or Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder. Personal care services are covered services under these Sections.
B. If the member resides in a Section 50, I CF-IDD, a Home Health Agency may provide services only if the facility's MaineCare reimbursement rate, or the facility's contract with the seeding state agency, does not include these services. Home health aide services shall not be reimbursed in Section 97 (PNMI) and Section 50 (ICF-IDD) settings because personal care services are a covered service under these Sections.
C. Nursing and home health aide services delivered to a member who is receiving Section 96, Private Duty Nursing (PDN) Services & Personal Care Services, shall count towards the member's authorized PDN cap. Occupational therapy, physical therapy, speech-language pathology and Medical Social Services may be provided and do not count toward the member's PDN cap.
D. Excluding members whose medical condition is "unstable" (as defined in Section 40.01-28 ), assessment and management services, as well as teaching and training services, are limited to two (2) certification periods or a maximum of one hundred twenty (120) days, per admission.
