Subsection 144-101-II-29.07 - LIMITS29.07-1 MaineCare members can receive services under only one Home and Community Waiver Benefit at any one time.29.07-2 The combined annual limit for members who receive Home Support (Remote or 1/4 hour), Community Support, or Shared Living, is fifty two thousand, four hundred and twenty five dollars ($52,425.00). This cap will be retroactive to July 1, 2017.29.07-3 Employment Specialist Services are provided on an intermittent basis with a maximum of ten (10) hours (forty (40) quarter hour units) each month.29.07-4 Home Accessibility Adaptations are limited to tenthous and dollars ($10,000) in a five(5) year period with an additional annual allowance up to three hundred dollars ($300) for repairs and replacement per year. General household repairs are not included in this service. All items in excess of five hundred ($500) dollars require documentation from physician or other appropriate professional such as OT, PT or Speech therapist that purchase is appropriate to meet the member's need. Medically necessary home modifications that cannot be obtained as a covered service under any other MaineCare benefit can be reimbursed under this section.29.07-5 A provider may only be reimbursed for providing transportation services when the cost of transportation is not a component of a rate paid for another service.29.07-6 Respite Services are limited to one thousand one hundred dollars ($1100.00) per year. This respite cap will be effective retroactive to July 1, 2017. Additionally, the quarter hour (1/4) billing for Respite shall not exceed the per diem limit of (Ninety dollars ($90.00) for each date of service. Reimbursement for Respite is a quarter (1/4) hour billing code. After thirty-three (33) quarter hour units of consecutive Respite Services, the provider must bill using the per diem billing code. The quarter hour (1/4) Respite amount billed any single day cannot exceed the Respite per diem rate of Ninety ($90.00) dollars.
29.07-7 Services reimbursed under this section are not available to members who reside in an ICF/IID, nursing facility or are inpatients of a psychiatric hospital or hospital.29.07-8Duplicative Services. A member may not receive services that are comparable or duplicative under another Section of the MaineCare Benefits Manual at the same time as services provided under this waiver benefit. Such comparable or duplicative services include, but are not limited to services covered under the MaineCare Benefits Manual, 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 21, Home and Community Benefits for Person with Intellectual Disabilities or Autism Spectrum Disorder; Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations; 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.29.07-9 A member may not receive Community Support while enrolled in high school. A member may not receive Community Support at his or her place of employment.29.07-10 A member may not receive Employment Specialist Services while enrolled in high school.29.07-11 Work Support Services are limited to one Direct Support Professional per member at a time.29.07-12 The total amount of Services authorized may not exceed 50% of the state-wide average annual cost of care for an individual in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), as determined by the Department.29.07-13 If a current waiver recipient enters a nursing facility or a hospital, payment under the waiver will be temporarily suspended. If the waiver recipient remains in the nursing facility or hospital for more than thirty (30) consecutive days, enrollment in this waiver will be terminated unless there is a written request to the Department to continue holding the funded opening.29.07-14 Assistive Technology services are not covered under this rule if they are available under another MaineCare rule. Assistive Technology services are subject to the following limits:
A. Assistive Technology-Assessment is subject to a combined limit of 32 units (8 hours) per year.B. Assistive Technology-Devices, including the selecting, fitting, customizing, adapting, applying, maintaining, repairing or replacing of assistive technology devices, is subject to a combined limit of $6,000 per year.C. Assistive Technology-Transmission (Utility Services) is subject to a combined limit of $50 per month.29.07-15 Career Planning is limited to 60 hours to be delivered in a six-month period. No two six-month periods may be provided consecutively.29.07-16Out of State Services Authorizations for services to be provided out of state will not exceed sixty (60) days of service within a given fiscal year and will not exceed sixty (60) days within any six (6) month period except as provided in 42 C.F.R. § 431.52(b). C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-29, subsec. 144-101-II-29.07