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-50 - ICF-MR Services
Appendix 144-101-II-A - SUPPLIES AND EQUIPMENT WHICH ARE PROVIDED AS PART OF THE ICF-MR REGULAR RATE OF REIMBURSEMENT
Current through 2024-38, September 18, 2024
The following supplies and equipment must be provided to a member by an ICF-MR as part of the facility's regular rate of reimbursement, when items are required by the member.
Facilities that serve a special group of disabled members are expected to furnish that equipment which is normally used in their care (e.g. children's wheelchairs) as a part of their reimbursement rate.
Neither the facility nor the supplier may bill for the following items:
1. Alcohol, swabs and rubbing
2. Analgesics, non-prescription including: aspirin: plain, buffered and coated, suppositories; acetaminophen: tablets, liquids and suppositories.
3. Antacids, non-prescription including: Aluminum/magnesium hydroxide (ex. Maalox); Aluminum/magnesium hydroxide with simethicone (ex. Mylanta, Maalox Plus); Calcium carbonate tablets (ex. Tums); Calcium carbonate/ magnesium hydroxide tablets (ex. Rolaids)
4. Alternating pressure pads, air mattresses, "Egg Crate" mattresses, gel mattresses
5. Applicators
6. Bandages
7. Bandaids
8. Basins
9. Beds (standard hospital type, not therapy beds)
10. Bed pans
11. Bed rails
12. Blood pressure equipment
13. Bottles (water)
14. Canes
15. Calcium supplements, non-prescription (ex. Tums, Oscal)
16. Catheters
17. Catheter trays (disposable)
18. Chairs (standard and geriatric)
19. Combs
20. Commodes
21. Corner chair
22. Cotton
23. Cough syrup and expectorants, all non-prescription brands
24. Crutches
25. Cushions (e.g., comfort rings)
26. Dietary supplements
27. Disinfectants
28. Douch trays (disposable)
29. Dressings
30. Enema equipment
31. Enteral feeding, supplies and equipment
32. Facility deodorants
33. Gauze bandages (sterile or non-sterile)
34. General services such as administration of oxygen and related medications, hand feeding, incontinency care, tray service, and enemas
35. Glucometers
36. Gloves (sterile and unsterile)
37. Gowns
38 Hemorrhoidal preparations
39. Ice bags
40. Incontinency supplies (full brief- all sizes; bedpad; undergarment liners, disposable or reusable; underpads)
41. Iron supplements
42. Irrigation trays
43. Laundry services, personal (including supplies and equipment)
44. Laxatives, non-prescription including: Stool softeners (ex. Docusate sodium liquid or capsule); Bulk: (ex. Psyllium); Stimulants: (ex. Bisacodyl tablets and suppositories; docusate casanthranol, liquid and/or capsule); Enemas: (ex. Saline, phosphate types-except Fleets); oil retention; Misc.: milk of magnesia; glycerin suppositories; lactulose and analogs (when used as a laxative); mineral oil.
45. Lotions (emollient)
46. Lubricants (skin, bath oil)
47. Mats
48. Mouth wash
49. Ointments and creams (available over the counter), including petroleum jelly and hydrocortisone 0.5%
50. Ophthalmic lubricants: tears, ointments
51. Oxygen, for emergency and prn use only, including portable oxygen and equipment
52. Parenteral solutions, supplies and equipment
53. Pillows
54. Pitchers (water)
55. Powders (medicated and baby)
56. Prone boards
57. Restraints (posey, thorasic chest supports, wedge pillows, etc.)
58. Sand and water tables
59. Sensory stimulation materials
60. Shampoo, regular; medicated; no tears baby shampoo
61. Sheepskin
62. Shower chairs
63. Soap: including hypoallergenic
64. Special dietary supplements
65. Specimen containers
66. Sterile I.V. or irrigation solution
67. Stethoscopes
68. Sunscreen - SPF 30
69. Supplies necessary for treatment of decubiti (non-prescription)
70. Suture sets
71. Swabs, medicated or unmedicated
72. Syringes and needles
73. Tapes
74. Testing materials to be used by staff of facility, not to include material normally included in psychometric testing
75. Thermometers
76. Tissues
77. Toothbrushes
78. Toothpaste
79. Towels, washcloths
80. Tongue depressors
81. Traction equipment
82. Trapezes
83. Tub seats
84. Tubes (gavage, lavage, etc.)
85. Underpads
86. Urinals
87. Urinary drainage equipment and supplies (disposable)
88. Velcro strips
89. Vestibular boards
90. Vitamins, non-prescription, all brands
91. Walkers
92. Wheelchairs - Standard: Chairs with removable arms and leg rests; wheelchairs with elevators; pediatric wheelchairs; "hemi" wheelchairs; reclining wheelchairs
93. Wipes, rectal medicated
94. Routine personal hygiene and grooming items to include, but not be limited to items for shaving, shampooing, bathing, nail clipping (unless specified as a covered service when performed by a podiatrist as covered under the MaineCare Benefits Manual), haircutting or the services of a barber when requested and paid for by the member.
95. Routine transportation of members or laboratory specimens to hospital or doctor's offices
