Subsection 144-101-II-20.06 - NONCOVERED SERVICESServices for which reimbursement is not allowed under this Section include, but are not limited to, the following:
20.06-1 Services not authorized by the Care Plan.20.06-2 Services to any member who is hospitalized, a nursing facility resident, or ICF/IID resident.20.06-3 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.20.06-4 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.20.06-5 Services provided directly or indirectly by the legal guardian.20.06-6 Work Support or Employment Specialist Services when the member is not engaged in employment. Employment means traditional employment or telecommuting that is compensated at a competitive wage, or self-employment or business ownership. A competitive wage is a wage at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by an employee without a disability. Employment does not include work in a setting in which the member has little or no interaction with customers or other employees not having a disability, unless the member is telecommuting, self-employed, or owns his or her own business.20.06-7 Specialized Medical Equipment and Supplies, Communication Aids, or Home Accessibility Adaptations unless the service has been determined non-reimbursable under Section 60, Medical Supplies and Durable Medical Equipment or other sections of the MaineCare Benefits Manual.2 0.06-8 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 45, Hospital Services; Section 46, Psychiatric Hospital Services; Section 50, I CF/IID; Section 67, Nursing Facilities and Section 97, Private Non-Medical Institutions. 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 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 Benefits 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-20, subsec. 144-101-II-20.06