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-29 - Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
GENERAL PROVISIONS
Subsection 144-101-III-29-1900 - AUDIT OF SERVICES PROVIDED
Current through 2024-38, September 18, 2024
The Department shall monitor provider's claims for reimbursement by randomly reviewing the claim for services and verifying hours actually provided by collecting documentation from providers. Documentation will be requested from providers that corresponds to dates of service on claims submitted for reimbursement as follows:
A. Payroll Records - Documentation showing the number of hours paid to an employee that covers the period of time for which the Direct Care hours are being requested.
B. Staffing Schedules per facility - Documentation showing the hours and the name of the direct care staff scheduled to work at the facility.
C. Member Records - Documentation that supports the delivery of services that a member received.
