Statutes, codes, and regulations
Maine Administrative Code
Department 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICESDivision 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERALChapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)Chapter II - Specific Policies By Service
Section 144-101-II-18 - RULES GOVERNING IMPLEMENTATION OF THE TRADE ADJUSTMENT ASSISTANCE PROGRAM
Subsection 144-101-II-18.06 - NONCOVERED SERVICES

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-18, subsec. 144-101-II-18.06

Download
PDF
Current through 2024-51, December 18, 2024
Subsection 144-101-II-18.06 - NONCOVERED SERVICES

Services for which reimbursement is not allowed under this Section include, but are not limited to, the following:

18.06-1 Services not authorized by the Care Plan.
18.06-2 Services to any member who is hospitalized, a nursing facility resident, or ICF/IID resident.
18.06-3 Any service otherwise reimbursable under the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act, including but not limited to job development and vocational assessment or evaluations.
18.06-4 Room and board. The term "room" means shelter-type expenses, including all property-related costs, such as rental or purchase of real estate and furnishings, maintenance, utilities, and related administrative services. The term "board" means three meals a day or any other full nutritional regimen.
18.06-5 Services provided directly or indirectly by the legal guardian, spouse, or a relative of the member.
18.06-6 Work Support when the member is not engaged in employment.
18.06-7 Assistive Technology unless the service has been determined non-reimbursable under Section 60, "Medical Supplies and Durable Equipment", the State Plan and/or other sections of the MaineCare Benefits Manual.
18.06-8 Non-Duplication of Services

Services as defined under this section if the member is receiving comparable or duplicative services under this or another section of the MaineCare Benefits Manual. A member may not receive services under this section, if the member is in a residential treatment facility or if the member is receiving services in an institution, including, but not limited to Section 2, "Adult Family Care Services"; Section 13, "Targeted Case Management Services"; Section 45, "Hospital Services"; Section 46, "Psychiatric Hospital Services"; Section 50, "ICF/IID Services"; Section 67, "Nursing Facility Services" and Section 97, "Private Non-Medical Institution Services". A member may not receive services if they are in another Home and Community Based Waiver such as Section 19, "Home and Community-Based Benefits for the Elderly and for Adults with Disabilities", Section 20, "Home and Community Based Services for Adults with Other Related Conditions", Section 21, "Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder", Section 22, "Home and Community Benefits for the Physically Disabled", Section 29, "Support Services for Adults with Intellectual Disabilities or Autistic Disorder" and Section 32, "Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders".

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-18, subsec. 144-101-II-18.06