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-65 - Behavioral Health Service
Subsection 144-101-II-65.06 - NON-COVERED SERVICES

Universal Citation: 10 ME Code Rules ยง 144-101-II-65.06

Current through 2024-38, September 18, 2024

Please refer to the MaineCare Benefits Manual, Chapter I, Section 1, "General Administrative Policies and Procedures", for a general listing of non-covered services including academic, vocational, socialization or recreational services and custodial services and associated definitions that are applicable to all Sections of the MaineCare Benefits Manual.

Additional non-covered services related to the delivery of mental health services are as follows:

65.06-1 Homemaking or Individual Convenience Services: Any services or components of services of which the basic nature is to maintain or supplement the housekeeping, homemaking or basic services for the convenience of the member are not reimbursable under this policy. These non-covered services include, but are not limited to, housekeeping, shopping, Child day care, or respite and laundry service.

65.06-2 Transportation Services: Costs related to transportation services are built into the rates for all services by allocation of non-personnel costs. Therefore, separate billings to the MaineCare Program for travel time are not reimbursable.

65.06-3 Case Management Services: Any services, or components of services of which the basic nature is to provide case management services are not reimbursable under these Behavioral Health Services rules unless otherwise indicated. Please refer to Chapter II, Section 13, "Targeted Case Management Services", Chapter II, Section 17, "Community Support Services", Chapter II, Section 92, "Behavioral Health Home Services, and Chapter II, Section 93, "Opioid Health Home Services" of the MaineCare Benefits Manual for a description of the coverage of such services.

65.06-4 Adult Community Support/Adult Day Treatment Services: Any services, or components of services of which the basic nature is to provide Adult Community Support Services, or Adult Day Treatment Services are not reimbursable under this Section. Please refer to Chapter II, Section 17, "Community Support Services", of the MaineCare Benefits Manual for a description of the coverage of such services.

65.06-5 Financial Services: Any services, or components of services of which the basic nature is to provide economic services to the member, such as financial or credit counseling are not covered under this Section.

65.06-6 Driver Education and Evaluation Program (DEEP) Evaluations: Any program, services or components of services of which the basic nature is to provide DEEP evaluations are not reimbursable under this Section.

65.06-7 Comparable or Duplicative Services: Services as defined under this Section are not covered if the member is receiving comparable or duplicative services under this or another Section of the MaineCare Benefits Manual.

1. Any Services provided as a Covered Service under Section 65 are not covered and are not reimbursable if the member is receiving another service under Section 65, except as set forth in the specific Covered Services and as follows:
a. Such concurrent services require Prior Authorization for a specified duration and amount by DHHS or an Authorized Entity, and

b. Such exceptions are documented in the member's ITP, and

c. Concurrent services are consistent with the provisions in the MaineCare services described in this Section and other MaineCare Benefits Manual Sections, and

d. There is a clear, documented clinical justification as to why concurrent treatment under this service is needed, as follows:
i. During the course of provision of a service the Clinician uncovers an issue requiring referral to specialized treatment (e.g., trauma, sexual abuse issue, substance use), or

ii. The service is necessary for a successful transition of the member to a different level of care.

2. Other such comparable or duplicative services include, but are not limited to, services covered under MaineCare Benefits Manual, Section 40, "Home Health Services", and Section 96, "Private Duty Nursing Services"; services that are duplicated by a Private Non-Medical Institution providing services under Section 97; services that are duplicated by a Section 13, "Targeted Case Management Services" provider; services that are duplicated by a Section 17, "Community Support Services" provider; services that are duplicated by a Section 92, "Behavioral Health Home Services" provider; services that are duplicated by a Section 93, "Opioid Health Home Services" provider; and other services described in this Section. Refer to Appendix II for further detail on comparable or duplicative services.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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