Current through 2024-51, December 18, 2024
Subsection 144-101-II-40.09 - REIMBURSEMENTA. The amount of payment for services rendered shall be the lowest of the following: 1. The amount listed in Chapter III, Section 40, "Allowances for Home Health Services" of the MaineCare Benefits Manual; or2. The lowest amount allowed by the Medicare carrier; or3. The provider's usual and customary charge.B. In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from every other source that is available for payment of a rendered service prior to billing MaineCare.C. The eligibility requirements and limits on Home Health Services under this Section do not apply to members with Medicare coverage or other third party health insurance until the coverage for these Home Health Services, (including occupational therapy, physical therapy and speech-language pathology services) by the other third party payor has been exhausted. MaineCare will cover the co-insurance and deductible in these cases.D. Only a Home Health Agency may receive reimbursement for telemonitoring services.E. Telemonitoring may not be billed as a waiver service. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-40, subsec. 144-101-II-40.09