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-97 - Private Non-Medical Institution Services
Subsection 144-101-II-97.04 - COVERED SERVICES - DIRECT SERVICE STAFF
Current through 2024-38, September 18, 2024
A covered service is a service for which payment to a PNMI provider is permitted under the rules of this Section. Direct service staff is defined as staff who provide the services listed in this Section. MaineCare covers the following services when provided in an approved setting of a licensed Private Non-Medical Institution in accordance with Chapter III, Principles of Reimbursement for Private Non-Medical Institution Services, provided within the scope of licensure of the facility, and billed by that facility, and as identified in Section 97.08. Not all of the following services are included in the rate for every type of facility. Refer to the applicable Appendix in Chapter III for services that are included in the rate for each type of PNMI. The Chapter III Principles of Reimbursement for each type of Private Non-Medical Institution define which staff services are allowable. The service must be listed in the Principles of Reimbursement in order for the service to be reimbursable. Covered services may include, but are not limited to:
97.04-1 Physician services
97.04-2 Psychiatrist services
97.04-3 Psychologist services
97.04-4 Psychological examiner services
97.04-5 Social worker services
97.04-6 Licensed clinical professional counselor services
97.04-7 Licensed professional counselor services
97.04-8 Dentist services
97.04-9 Registered nurse services
97.04-10 Licensed practical nurse services
97.04-11 Psychiatric nurse services
97.04-12 Speech pathologist services
97.04-13 Licensed alcohol and drug counselor services
97.04-14 Occupational therapy services
97.04-15 Other qualified mental health staff services
97.04-16 Other qualified medical and remedial staff services
97.04-17 Other qualified alcohol and drug treatment staff services
97.04-18 Personal care services
97.04-19 Other qualified childcare facility services
97.04-20 Other qualified licensed treatment foster care provider services
97.04-21 Interpreter services
97.04-22 Nurse practitioner services
97.04-23 Physician assistant services
97.04-24 Clinical consultant services
97.04-25 Physical therapy services
