Subsection 144-101-II-20.07 - LIMITSThe following service limits apply to each member:
20.07-1Assistive Technology Services- Each system or device will be reviewed based on medical necessity, efficiency and whether it meets compatibility with safety needs. Assistive Technology Services are limited to as described in the covered service 20.05-1. * The Assistive Technology Device and services described in 20.05-1(B) and (C) are subject to a combined limit of $6,000.00 annually.
* The services described in 20.05-1(A), (D), (E) and (F) are subject to a combined limit of 32 units (8 hours) annually.
* The data transmission utility costs described in 20.05-1(G) are limited to $50.00 per month.
20.07-2Care Coordination Services-Care Coordination Services are limited to 400 units per year. The Care Coordination provider may not offer any other services to the member under this Section.20.07-3Communication Aids- Communication Aids are limited to $6000.00 per service year. Each system or device will be reviewed based on medical necessity, efficiency and whether it meets compatibility with safety needs.20.07-4Community Support Services-Community Support Services are limited to 128 units per week, for an annual total of 6656 units per service year. The maximum weekly allowance for Work Support Services is 128 units, for an annual total of 6656 units. When members use a combination of both services, there is a weekly limit of 128 units per week and an annual limit of 6656 units on the total combined expenditures for the services.20.07-5Consultation Services-Consultation Services are limited to 64 units per service year, each type of Consultation Service.20.07-6Employment Specialist Services- Employment Specialist Services are limited to 72 units per service year.20.07-7Home Accessibility Adaptions- Home Accessibility Adaptions are limited to $3,000.00 per service year.20.07-8Home Support Services- Home Support (1/4 hour) is limited to 64 units per day. Home Support (Remote Support) is limited to 64 units per day.20.07-9Non-Traditional Communication Assessment- Non-Traditional Communication Assessment is limited to 64 units per service year.20.07-10Non-Traditional Communication Consultation- Non-Traditional Communication Consultation is limited to 64 units per service year.20.07-11Occupational Therapy Maintenance- Occupational Therapy Maintenance is limited to 8 units per week up to 416 units per service year.20.07-12Personal Care Services- Personal Care Services are limited to 52 units per day.20.07-13Physical Therapy Maintenance- Physical Therapy Maintenance is limited to 8 units per week up to 416 units per service year.20.07-14Specialized Medical Equipment and Supplies- Any item over $500.00 requires documentation from a physician, an Occupational Therapist, Physical Therapist or Speech Therapist.20.07-15Speech Therapy Maintenance- Speech Therapy Maintenance is limited to 8 units per week up to 416 units per service year.20.07-16Work Support Services-Work Support Services are limited to 128 units per week up to 6656 units per service year. The maximum weekly allowance for Community Support is 128 units, for an annual total of 6656 units. When members use a combination of both services there is an annual limit of 6656 units on the total combined expenditures for the services.20.07-17Section 20 Home and Community Based Services for Adults with Other Related Conditions may not be provided in a residence where other Home and Community Based Waiver services are provided. Exceptions to this limit will be considered on a case-by-case basis by the Department. Consideration of this exception will be contingent on the member's Care Plan ensuring that all identified services will be delivered without compromising the quality of care, and on all aspects of the costs of services being clearly delineated in order to demonstrate that there is not blending of financial benefits between the members served. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-20, subsec. 144-101-II-20.07