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
Subsection 144-101-III-21-1300 - REIMBURSEMENT METHODS

Universal Citation: 10 ME Code Rules § 144-101-III-21-1300

Current through 2024-38, September 18, 2024

Services covered under this section will be reimbursed on a fee for service basis using one of these methods as follows:

1. Standard Unit Rate A Standard unit rate is the rate paid per unit of time (an hour, a specified portion of an hour, or a day) for a specific service. Services paid for using a standard rate are as follows:

A. Assistive Technology-Assessment;

B. Assistive Technology-Transmission (Utility Services);

C. Career Planning;

D. Community Support Services

E. Communication Aids-Ongoing Visual-Gestural and Augmented Communications;

F. Consultation Services;

G. Counseling;

H. Crisis Intervention;

I. Crisis Assessment;

J. Employment Specialist Services;

K. Home Support-Agency;

L. Home Support-Quarter Hour (1/4 hour);

M. Home Support-Family-Centered Support;

N. Home Support-Remote Support- Monitor Only;

O. Home Support-Remote Support- Interactive Support;

P. Non-Traditional Communication Consultation;

Q. Non-Traditional Communication Assessments;

R. Occupational Therapy (Maintenance) Service;

S. Physical Therapy (Maintenance) Service;

T. Shared Living;

U. Speech Therapy (Maintenance) Service-Individual;

V. Speech Therapy (Maintenance) Service-Group;

W. Work Support- Individual;

X. Work Support-Group;

The standard rates for these services are listed in Appendix I.

2. Prior Approved Price - The price of an item or piece of equipment being purchased for a member must be reviewed and approved by DHHS before it will be reimbursed.

A. Home Accessibility Adaptations - The DHHS will determine the amount of reimbursement after reviewing a minimum of two written itemized bids from different vendors submitted by the provider. Prior to services being delivered, written itemized bids must be submitted to the DHHS for approval and must contain cost of labor and materials, including subcontractor amounts. The DHHS will issue an authorization for the approved amount based on the written bids to the provider.

B. Specialized medical equipment and supplies and Communication Aids- Speech Amplifiers, Aids, Communicators, Assistive Devices - The amount of payment for specialized medical equipment and supplies, and communication aids equipment, Speech Amplifiers, Aids, Communicators, Assistive Devices or Assistive Technology Devices shall be the lowest of:

1. Maximum MaineCare amount listed by applicable corresponding HCPCS codes published at least annually on the Department's website,

https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx and made available to providers;

2. The provider's usual and customary charges; or 3. The manufacturer's suggested retail price for any medical supply or medical equipment.

3. Per Diem Reimbursement: This method of reimbursement is used for Home Support Services provided by an agency. For purposes of Paragraphs 1300 through 1500, an agency is a provider that routinely employs direct care staff to provide Home Support Services to members in a facility operated by the agency.

The per diem rate is calculated using the number of Agency Home Support hours authorized or provided for each member served in the agency's facility and the standard unit rates for Agency Home Support listed in Appendix I. The calculation includes a small range of permissible variance between the number of hours authorized and the number of hours actually provided. The standard unit rates listed in Appendix I will be reduced by $3.38 for each hour of Home Support Service provided to the member in excess of 168 hours per week. Paragraph 1400 explains the method of calculating the per diem rate, and Appendix IIA sets forth instructions and a chart for use in calculating the per diem rate.

The authorized per diem rate for all members is based on the total weekly hours authorized by DHHS for all members in the facility. The amount of the agency's per diem rate is calculated using the chart in Appendix II and the rates for Agency Home Supports set forth in Appendix I. In performing these calculations, the standard unit rates listed in Appendix I will be reduced by $3.38 for each hour of agency Home Support Service provided to the member in excess of 168 hours per week.

Only hours of services that have been authorized and provided with a Medical Add On for Agency Home Support for a member will be reimbursed at the Medical Support reimbursement rate.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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