C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-96, subsec. 144-101-II-96.08

Current through 2024-51, December 18, 2024

Subsection 144-101-II-96.08 - REIMBURSEMENT

96.08-1Reimbursement for Private Duty Nursing and Personal Support Services

Reimbursement will be made on the unit rate as specified in Chapter III of this Section and shall be the lower of:

A. The amount listed in Chapter III, Section 96, "Allowances for Private Duty Nursing and Personal Care Services"; or

B. The provider's usual and customary charge.

In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from any other sources that are available for payment of the rendered service prior to billing the MaineCare Program.

96.08-2Licensed Home Health Care Agencies

In order to qualify for reimbursement under this Section as a Home Health Care Agency, the Home Health Agency must have in effect a license pursuant to the Department's Regulations Governing the Licensing and Functioning of Home Health Care Services, as are currently in effect. These standards are incorporated into this Section by reference as if set out fully herein.

96.08-3Registered Personal Care Agency

In order to qualify for reimbursement under this Section as a Personal Care Agency, the Agency must have in effect a registration pursuant to the Department's "Rules and Regulations Governing In-Home Personal Care and Support Workers", as are currently in effect.

96.08-4Licensed Assisted Living Agency

In order to qualify for reimbursement under this Section as a Licensed Assisted Living Agency, the Agency must be licensed with the Department as an assisted living program and hold a valid contract with the Office of Aging and Disability Services to provide services, and employ CRMAs to serve MaineCare Members who have daily medication administration needs.

96.08-5Family Provider Service Option Rates

The rates for family provider services consist of two components:

a) PSS services rate, which is the portion of the family provider services rate that is designated as the PSS's gross hourly wage for authorized care provided by the family provider;

b) Family provider expense component, which is the portion of the family provider services rate designated for the mandated employer's share of Social Security, Federal and State unemployment taxes, Medicare, and Workers' Compensation insurance premiums.

96.08-6Service Coordination Agency

In order to qualify for reimbursement under this Section as a Service Coordination Agency, the Agency must have met the MaineCare provider enrollment requirements of the Department and any additional provider qualifications required by the Office of Aging and Disability Services.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-96, subsec. 144-101-II-96.08