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-96 - Private Duty Nursing and Personal Care Services
Appendix 144-101-II-#2 - LEVEL OF CARE CAPS
Members are assigned to a level of care based upon the eligibility criteria in Section 96.02.
The Department is seeking and anticipates receiving CMS approval for this Section. There are three separate proposed rate changes pending before CMS: one that was submitted in September 2016, one submitted in September 2017, and one submitted in July 2018; thus there are three retroactive effective dates applicable for these rates. Pending CMS approval, the following levels of care will be effective. Members under the age of 21 years can exceed the caps when it is medically necessary as outlined under Section 96.03(A). Reimbursement of care coordination and skills training do not count toward the monthly cost caps.
|
Level of Care |
Effective 7/29/16 to 6/30/17 and 7/1/18 to 7/31/18 |
Effective 7/1/17 to 6/30/18 |
Effective 8/1/18 to 6/30/19 |
Effective 7/1/19 |
|
Level I |
$925/month |
$1,092/month |
$1,124.00/month |
$1,114.00/month |
|
Level II |
$1,165/month |
$1,375/month |
$1,415.00/month |
$1,402.00/month |
|
Level III |
$1,904/month |
$2,248/month |
$2,314.00/month |
$2,292.00/month |
|
Level IV (under 21 years of age, only) |
$3,532/month |
$4,041/month |
$4,160.00/month |
$4,119.00/month |
|
Level V |
$23,966/month |
$27,420/month |
$28,222.00/month |
$27,941.00/month |
|
Level VIII |
$847/month |
$938/month |
$966.00/month |
$957.00/month |
|
Level IX |
$1,769/month |
$2,088/month |
$2,149.00/month |
$2,129.00/month |
