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
Subsection 144-101-II-50.13 - REIMBURSEMENT

A per diem rate of reimbursement for routine services and certain supplies and equipment is established according to Section 50, Chapter III, and payment is made directly to the facility as a MaineCare vendor payment.

If a service is covered in the per diem rate, the ICF-MR may not utilize personnel or organizations that bill MaineCare separately for MaineCare payment for services rendered to ICF-MR residents.

For therapy consultations, as described in Sections 50.07-3(H) and 50.07-4(F), provided to ICFs-MR, reimbursement must be at reasonable cost according to Principles of Reimbursement for ICF-MR Section 5010.

Please see Sections 50.06-5, Payment of Bed Holds for Short-Term Hospitalizations, 50.06-6, Leave of Absence, 50.07-3(G), PT and OT Services, and 50.07-4(E), Speech and Hearing Services for detailed information on reimbursement limitations for these areas of this policy.

The reimbursement rate for the developmental training program shall be established by the Department.

In accordance with Chapter 1 of the MaineCare Benefits Manual, it is the responsibility of the provider to seek reimbursement from any other sources that are available for payment of the rendered service prior to billing MaineCare.