Subsection 144-101-II-21.06 - NON-COVERED SERVICESServices for which reimbursement is not allowed under this Section include, but are not limited to, the following:
21.06.1Duplicative Services A Member receiving services under this Section 21, may not receive duplicative MaineCare services at the same time under any other sections of the MaineCare Benefits Manual, including: Section 2, Adult Family Care Services; Section 18, Home and Community-Based Services for Adults with Brain Injury; Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities; Section 20, Home and Community-Based Services for Adults with Other Related Conditions; Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations; Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder; Section 45, Hospital Services; Section 46, Psychiatric Facility Services; Section 50, I CF/IID Services; Section 67, Nursing Facility Services, and Section 97, Private Non-Medical Institution Services, when the Member is receiving personal care services.21.06-2 Services not identified by the Person-Centered Service Plan;21.06-3 Services to any MaineCare Member who receives services under any other federally approved MaineCare Home and Community based waiver program;21.06-4 Services to any Member who is a nursing facility resident, state psychiatric hospital or ICF/IID resident;21.06-5 Services that are reimbursable under any other sections of the MaineCare Benefits Manual;21.06-6 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;21.06-7 Room and board is not reimbursed by MaineCare. 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. Board does not include the provision of a meal or snacks at an adult day health or similar facility outside the Member's home. Board also does not include the delivery of a single meal to a Member at his/her own home through a meals-on-wheels service;21.06-8 Services provided directly or indirectly by the legal guardian will not be reimbursed unless the legal guardian is the Member's parent, sibling or other biological family member. This rule will not be avoided by adult adoption. Persons appointed by a probate court as legal guardian prior to and up to December 30, 2007, who are not biological family, and who are directly or indirectly reimbursed for services, may continue to receive reimbursement under this Section. Relatives who provide waiver services must meet the same standards as providers who are unrelated to the Member;21.06-9 Work Support-Individual, Work Support-Group or Employment Specialist Services when the Member is not engaged in employment; and21.06-10 Specialized Medical Equipment and Supplies, Communication Aids, or Home Accessibility Adaptations unless the service has been determined non-reimbursable under Medical Supplies and Durable Equipment, Section 60 or other sections of the MaineCare Benefits Manual. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-21, subsec. 144-101-II-21.06