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 III - Allowances for Services
Section 144-101-III-21 - Allowances for Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder
GENERAL PROVISIONS
Appendix 144-101-III-21-I
|
PROCEDURE CODE |
DESCRIPTION |
MAXIMUM ALLOWANCE Effective 1/1/2022* |
|
HOME SUPPORT: AGENCY |
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|
T2016 |
AGENCY HOME SUPPORT (Habilitation, residential, waiver) |
See Appendix II and IIB Per diem* |
|
T2016 SC |
AGENCY HOME SUPPORT (Habilitation, residential, waiver) with Medical Add On |
See Appendix II and IIB Per diem* |
|
HOME SUPPORT: QUARTER HOUR |
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|
T2017 |
HOME SUPPORT (Habilitation, residential, waiver) |
$10.45 1/4 hr.* |
|
T2017 SC |
HOME SUPPORT (Habilitation, residential, waiver) with Medical Add On |
$10.45 1/4 hr.* |
|
HOME SUPPORT: REMOTE SUPPORT |
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T2017 QC |
HOME SUPPORT (Habilitation, residential, waiver)-REMOTE SUPPORT-Monitor Only |
$2.93 1/4 hr.* |
|
HOME SUPPORT: FAMILY CENTERED SUPPORT |
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T2016 U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support -One member served |
$143.03 Per diem* |
|
T2016 TG U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support -One member served- increased level of support |
$305.52 Per diem* |
|
T2016 UN U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Two members served |
$117.80 Per diem* |
*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
|
PROCEDURE CODE |
DESCRIPTION |
MAXIMUM ALLOWANCE Effective 1/1/2022 |
|
T2016 UN TG U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Two members served- increased level of support |
$277.70 Per diem* |
|
T2016 UP U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Three members served |
$100.45 Per diem* |
|
T2016 UP TG U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Three members served- increased level of support |
$252.06 Per diem* |
|
T2016 UQ U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Four members served- |
$85.13 Per diem* |
|
T2016 UQ TG U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Four members served- increased level of support |
$229.44 Per diem* |
|
T2016 UR U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Five or more members served |
$75.92 Per diem* |
|
T2016 UR TG U5 |
HOME SUPPORT (Habilitation, residential, waiver)- Family-Centered Support-Five or more members served- increased level of support |
$216.35 Per diem* |
|
SHARED LIVING |
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|
S5140 |
SHARED LIVING (Foster Care, adult)-Shared Living Model-One member served |
$163.71 Per diem* |
|
S5140 TG |
SHARED LIVING (Foster Care, adult)-Shared Living Model-One member served- increased level of support |
$241.75 Per diem* |
|
S5140 UN |
SHARED LIVING (Foster Care, adult)-Shared Living Model-Two members served |
$122.78 Per diem* |
|
S5140 UN TG |
SHARED LIVING (Foster Care, adult)-Shared Living Model-Two members served- increased level of support |
$184.17 Per diem* |
*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
|
PROCEDURE CODE |
DESCRIPTION |
MAXIMUM ALLOWANCE Effective 1/1/2022 |
|
H2023 |
WORK SUPPORT (supported employment)-Individual |
$12.59 1/4 hr.* |
|
H2023 SC |
WORK SUPPORT (supported employment)- with Medical Add On |
$12.59 1/4 hr.* |
|
H2023 UP |
WORK SUPPORT (supported employment)-Group 3 members served |
up to $4.68per 1/4 hr.* |
|
H2023 UQ |
WORK SUPPORT (supported employment)-Group 4 members served |
up to $3.82per 1/4 hr.* |
|
H2023 UR |
WORK SUPPORT (supported employment)-Group 5 members served |
up to $3.33 per 1/4 hr.* |
|
H2023 US |
WORK SUPPORT (supported employment)-Group 6 members served |
Up to $2.98per 1/4 hr.* |
|
T2015 |
CAREER PLANNING (Habilitation, prevocational) |
$61.13 hr.* |
|
T2019 |
EMPLOYMENT SPECIALIST SERVICES (Habilitation, supported employment waiver) |
$14.41 1/4 hr.* |
|
T2019 SC |
EMPLOYMENT SPECIALIST SERVICES (Habilitation, supported employment waiver)- with Medical Add-On |
$14.41 1/4 hr.* |
|
T2021 |
COMMUNITY SUPPORT (Day habilitation, waiver) |
$6.53 1/4 hr. |
|
T2021 SC |
COMMUNITY SUPPORT (Day habilitation, waiver) with Medical Add On |
$8.05 1/4 hr. |
|
97755 |
ASSISTIVE TECHNOLOGY-ASSESSMENT |
$15.15 1/4 hr.* |
|
T2035 |
ASSISTIVE TECHNOLOGY -TRANSMISSION (Utility Services) |
Up to $50.00 per month. |
|
A9279 |
ASSISTIVE TECHNOLOGY -DEVICES (Monitoring feature/device, stand alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) |
Per invoice up to $6296.40 per year* |
|
T2029 |
SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES |
Per itemized invoice |
*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
|
PROCEDURE CODE |
DESCRIPTION |
MAXIMUM ALLOWANCE Effective 1/1/2022 |
|
|
S5165 CG |
HOME ACCESSIBILITY ADAPTATIONS (Repairs) |
Per itemized invoice |
|
|
S5165 |
HOME ACCESSIBILITY ADAPTATIONS (Home Modifications) |
Per itemized invoice |
|
|
V5274 |
COMMUNICATION AIDS - SPEECH AMPLIFIER, AIDS, COMMUNICATORS (INCLUDING REPAIR AND MAINTENANCE), ASSISTIVE DEVICES |
Per itemized invoice |
|
|
T1013 GN |
COMMUNICATION AIDS - ONGOING VISUAL-GESTURAL AND FACILITATED COMMUNICATIONS SERVICES |
$6.13 1/4 hr.* |
|
|
G9007 |
NON-traditional communication CONSULTATION |
$ 9.44 1/4 hr.* |
|
|
92507 |
NON-traditional communication assessment |
$9.44 1/4 hr.* |
|
|
G9007 HI |
CONSULTATIVE SERVICES - BEHAVIORAL |
$15.58 1/4 hr.* |
|
|
G9007 GO |
CONSULTATIVE SERVICES - OCCUPATIONAL THERAPY |
$6.13 1/4 hr.* |
|
|
G9007 GP |
CONSULTATIVE SERVICES - PHYSICAL THERAPY |
$6.13 1/4 hr. * |
|
|
H0031 |
CONSULTATIVE SERVICES - PSYCHOLOGICAL |
$20.78 1/4 hr.* |
|
|
G9007 GN |
CONSULTATIVE SERVICES - SPEECH THERAPY |
$6.13 1/4 hr.* |
|
|
H0004 SC |
COUNSELING |
$13.50 1/4 hr. |
|
|
T1023 |
CRISIS ASSESSMENT |
$2361.15 Per Encounter* |
|
|
92507 |
CRISIS INTERVENTION SERVICES |
$8.16 1/4 hr.* |
|
|
S8990 GO |
OCCUPATIONAL THERAPY (MAINTENANCE) OT/L |
$10.01 1/4 hr.* |
|
*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
**These rates are used in conjunction with Appendix IIA and IIB to calculate the Home Support Agency Per Diem rate.
|
PROCEDURE CODE |
DESCRIPTION |
MAXIMUM ALLOWANCE Effective 1/1/2022 |
|
S8990 GO U1 |
OCCUPATIONAL THERAPY (MAINTENANCE)- Licensed Occupational Therapy Assistant (OTA/L) under the supervision of an Occupational Therapist, Licensed (OT/L) |
$8.99 1/4 hr.* |
|
S8990 GP |
PHYSICAL THERAPY (MAINTENANCE) |
$ 10.20 1/4 hr.* |
|
S8990 GN |
SPEECH THERAPY (MAINTENANCE)-Individual |
$ 13.10 1/4 hr.* |
|
S8990 GN HQ |
SPEECH THERAPY (MAINTENANCE)-Group |
$ 9.82 1/4 hr.* |
*The Department is seeking and anticipates receiving approval from the federal Centers for Medicare and Medicaid Services for these changes.
**These rates are used in conjunction with Appendix IIA and IIB to calculate the Home Support Agency Per Diem rate.
MODIFIERS DESCRIPTIONS
GO Service delivered under an outpatient occupational therapy plan of care
GP Services delivered under an outpatient physical therapy plan of care
HQ Group Setting
CG Policy criteria applied
GN Services delivered under an outpatient speech language pathology plan of care
HI Behavioral Consultation
GT Remote Support-Interactive Support
QC Remote Support-Monitor Only
U5 Home Support-Family Centered Support
SC Medically necessary service or supply
TG Complex/high tech level of care
UN Two members served
UP Three members served
UQ Four members served
UR Five members served
US Six members served
U1 Other Qualified Staff
*Provider calculated, in accordance with base rates listed at Appendices IIA & IIB. For assistances with calculations see Tables 1 & 2 accessible through the DHHS website:
http://www.maine.gov/dhhs/oads/MaineCare/index.shtml
or by calling 1-866-5585 (TTY): 711.
