C.M.R. 10, 144, ch. 101, ch. X, § 144-101-X-1, subsec. 144-101-X-1.06

Current through 2024-51, December 18, 2024

Subsection 144-101-X-1.06 - NON-COVERED SERVICES

The following MaineCare categories of services and respective policies of the MBM are not included in the enrollee participant package. In the event a service category is placed in a different Section of the MCBM than what is indicated below, the service category will remain non-covered for this benefit.

General Category of Service	Services
Adult Family Care	MBM Chapter II, Section 2, Adult Family Care Services
Consumer Directed Attendant	MBM Chapter II, Section 12, Consumer Directed Attendant Services
Home and Community Benefits for the Elderly and Adults with Disabilities	MBM Chapter II, Section 19, Home and Community Benefits for the Elderly and for Adults with Disabilities
Home and Community Benefits	MBM Chapter II, Section 21, Home and Community Benefits for Persons with Intellectual Disabilities or Autistic Disorder; Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorder; Section 20, Home and Community-Based Services for Adults with Other Related Conditions; Section 18, Home and Community-Based Services for Adults with Brain Injury
Private Non-Medical Institutions	MBM Chapter II, Section 97, Private Non-Medical Institution Services
Day Health	MBM Chapter II, Section 26, Day Health Services
Home Health	MBM Chapter II, Section 40, Home Health Services
Hospice	MBM Chapter II, Section 43, Hospice Services
Medical Supplies and Durable Medical Equipment	MBM Chapter II, Section 60, Medical Supplies and Durable Medical Equipment
Nursing Facility	MBM Chapter II, Section 67, Nursing Facility Services
Optician, Optometrist	MBM Chapter II, Section 75, V ision Services (Ophthalmologist services are covered if the services are provided by a qualified practitioner billing under MBM Section 90, Physician Services
Physical Therapy	MBM Chapter II, Section 85, Physical Therapy Services, except when provided by a qualified provider billing under MBM, Section 90, Physician Services, Section 31, Federally Qualified Health Center Services, Section 9, I ndian Health Services, or Section 45, Hospital Services
Private Duty Nursing and Personal Care	MBM Chapter II, Section 96, Private Duty Nursing and Personal Care Services
Primary Care Case Management	MBM Chapter VI, Section 1, Primary Care Case Management
Speech-Language Pathology	MBM Chapter II, Section 109, Speech and Hearing Services, except when provided by a qualified provider billing under MBM, Section 90, Physician Services, Section 31, Federally Qualified Health Center Services, Section 9, I ndian Health Services, or Section 45, Hospital Services
Speech and Hearing Services and Audiology	MBM Chapter II, Section 109, Speech and Hearing Services
Chiropractic	MBM Chapter II, Section 15, Chiropractic Services
Dental	MBM Chapter II, Section 25, Dental Services
Intermediate Care Facility for Persons with Intellectual Disability	MBM Chapter II, Section 50, I CF-ID Services
Occupational Therapy	MBM Chapter II, Section 68, Occupational Therapy Services, except when provided by a qualified provider billing under MCBM, Section 90, Physician Services, Section 31, Federally Qualified Health Center Services, Section 9, I ndian Health Services, or Section 45, Hospital Services
Podiatric	MBM Chapter II, Section 95, Podiatric Services
Rehabilitative Services	MBM Chapter II, Section 102, Rehabilitative Services
The Department shall seek and anticipates receiving approval for this section from the Centers for Medicare and Medicaid Services (CMS). Pending approval, non-covered services will include Dialysis Services	MMB Chapter II, Section 7, Free-standing Dialysis Services