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
Subsection 144-101-II-96.05 - NON-COVERED SERVICES

A. Services for which the cost exceeds the limits described in this Section, except as described in 96.03(A);

B. Psychiatric nursing services, except as described under Section 96.04(A);

C. Those services that can be reasonably obtained by the Member outside his/her place of residence;

D. Unless qualified for the "special circumstances nursing" (see Section 96.04(B), nursing services when provided by the Member's husband or wife, natural or adoptive parent, child, or sibling, stepparent, stepchild, stepbrother or stepsister, father in law, mother in law, son in law, daughter in law, brother in law, sister in law, grandparent or grandchild, spouse of grandparent or grandchild or any person sharing a common abode as part of a single family unit;

E. Personal care services provided by a spouse of the Member, the parents or stepparents of a minor child, or a legally responsible relative;

F. Homemaker and chore services not directly related to medical necessity. Homemaker and chore services are covered in this Section only as authorized by the ASA in the plan of care when required;

G. Services in an ICF-IID, nursing facility or hospital;

H. Services to Members receiving any Home and Community Benefits for the Elderly, or Adults with Disabilities (nursing and personal care services are covered under these waiver benefits);

I. Escorting Members outside of the home, except as described in Section 96.01-3 or 96.04(C);

J. Custodial care or respite care;

K. Except for those services delivered under Level IX, personal care services delivered in an Adult Family Care Home setting or other licensed Assisted Living Facility that is reimbursed for providing personal care services It is the responsibility of the AFCH or assisted living provider to deliver personal care services;

L. Personal care services may not be provided under this Section to Members receiving Section 18, "Home and Community-Based Services for Adults with Brain Injury"; Section 19, "Home and Community-Based Services for the Elderly and Adults with Disabilities"; Section 20, "Home and Community-Based Services for Adults with Other Related Conditions"; Section 21, "Home and Community Benefits for Persons with Intellectual Disabilities or Autism Spectrum Disorder"; or Section 29, "Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorders." Personal care services are covered services under these Waivers. Waiver Members may only receive nursing services under this Section;

M. Supervisory visits made for the purpose of supervising home health aides, certified nursing assistants or personal care assistants;

N. Services which are not approved by the plan of care; or

O. Services in excess of 40 hours per week, provided by an individual PSS, home health aide or certified nursing assistant, for an individual Member.