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-96.08 - REIMBURSEMENT
Current through 2024-38, September 18, 2024
96.08-1 Reimbursement for Private Duty Nursing and Personal Support Services
Reimbursement will be made on the unit rate as specified in Chapter III of this Section and shall be the lower of:
In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from any other sources that are available for payment of the rendered service prior to billing the MaineCare Program.
96.08-2 Licensed Home Health Care Agencies
In order to qualify for reimbursement under this Section as a Home Health Care Agency, the Home Health Agency must have in effect a license pursuant to the Department's Regulations Governing the Licensing and Functioning of Home Health Care Services, as are currently in effect. These standards are incorporated into this Section by reference as if set out fully herein.
96.08-3 Registered Personal Care Agency
In order to qualify for reimbursement under this Section as a Personal Care Agency, the Agency must have in effect a registration pursuant to the Department's "Rules and Regulations Governing In-Home Personal Care and Support Workers", as are currently in effect.
96.08-4 Licensed Assisted Living Agency
In order to qualify for reimbursement under this Section as a Licensed Assisted Living Agency, the Agency must be licensed with the Department as an assisted living program and hold a valid contract with the Office of Aging and Disability Services to provide services, and employ CRMAs to serve MaineCare Members who have daily medication administration needs.
96.08-5 Family Provider Service Option Rates
The rates for family provider services consist of two components:
96.08-6 Service Coordination Agency
In order to qualify for reimbursement under this Section as a Service Coordination Agency, the Agency must have met the MaineCare provider enrollment requirements of the Department and any additional provider qualifications required by the Office of Aging and Disability Services.
