10-144-101 Me. Code R. § III-97-B-2400

Current through 2024-51, December 18, 2024

Section 144-101-III-97-B-2400 - SERVICE COMPONENTS OF THE STANDARD RATE

Providers must follow all State of Maine licensing regulations and guidelines for staffing levels and must maintain professional staffing sufficient to serve the individual needs of each recipient as reflected in his individual service plan (as defined in Chapter II, §97.) Professional services may be provided only within the scope of the professional's license.

2400.1 The standard per diem rates provided for Detoxification (non-hospital based), Halfway House Services, Extended Care, Residential Rehabilitation Services (Type I), Residential Rehabilitation Services (Type II), Adolescent Residential Rehabilitation and Personal Care Substance Use (Substance Use Shelter Services) are intended to include the service costs listed below. Providers may not bill separately under this section or any other section of the MaineCare Benefits Manual for providing these services. Salaries and wages for direct service staff and services listed below:

Physicians

Psychiatrists

Psychologists

Licensed clinical social workers

Licensed clinical professional counselors

Licensed professional counselors

Licensed marriage and family therapists

Registered nurses

Practical nurses

Licensed alcohol and drug counselors

Psychiatric nurses

Personal care services staff

Clinical Consultants

Other qualified alcohol and drug treatment staff as defined in Section 97.07-2, of the MaineCare Benefits Manual.

It is the responsibility of the PNMI to provide and coordinate all covered services performed by direct care staff listed in this Section to assure that members receive the full range of services necessary to meet members' needs without duplication of services. See MaineCare Benefits Manual (MBM), Chapter II, Section 97, Sections 97.04 and 97.05 regarding covered services and non-duplication of services.

2400.2 The Department shall determine the reasonableness of the treatment costs on an annual basis. Providers must submit any requested data to the Department including, but not limited to, utilization data.

2410 The rates in this Section include a State-mandated service tax. The State-mandated service tax is a tax on the value of PNMI services pursuant to 36 M.R.S. §2552. Since providers will no longer receive Rate letters detailing this information, they will need to calculate the service tax of reimbursed services.

2460 The total costs shall be allocated to rehabilitation and to personal care.

10-144 C.M.R. ch. 101, § III-97-B-2400