Section 144-101-III-97-D-2400 - SERVICE COMPONENTS OF THE STANDARD RATEProviders must follow all State of Maine Licensing guidelines for staffing levels and must maintain specific staffing listed below sufficient to serve the individual needs of each child as identified in the child's individual service plan (as defined in Chapter II, Section 97) and approved by the Department. Staffing is also detailed in MBM, Chapter II, Section 97. Services may only be provided within scope of licensure for the respective professional.
2400.1 Appendix D PNMI services for: Intellectual Disabilities/Developmental Disabilities, Mental Health, and Crisis Stabilization Residential Services include the following components in the standardized rate, which may not be billed separately under this or other Sections of MaineCare: b. Psychologist services - treatment/not testingc. Licensed clinical social worker servicesd. Licensed clinical professional counselor servicese. Licensed professional counselor servicesf. Licensed practical nurse servicesg. Psychiatric nurse servicesh. Licensed alcohol and drug counselor servicesi. Behavioral Health Professionalk. Other Qualified Mental Health Professionall. Behavioral Health Professional servicesm. Board certified behavior analyst services*n. Board certified assistant behavior analyst*o. Registered behavior technician services**The Department shall seek CMS approval for these changes.
Appendix D PNMI services for Therapeutic Foster Care include the following components in the standardized rate, which may not be billed separately under this or other Sections of MaineCare:
a. Therapeutic Foster Care Parentsb. Licensed Social Worker Servicesc. Other Qualified Child Care Professionald. Other Qualified Child Care Facility Professional. Direct service staff who meet residential licensing requirements are considered to be an allowable expense within an Appendix D facility.
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 resident 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.2400.3 Other qualified therapeutic foster care providers (Chapter 2, Section 97.07-2 of the MaineCare Benefits Manual). Reimbursement to foster parents for care of children in placement shall be limited to 60% of the wages and taxes/fringe benefits (as defined under Sections 2400.1 and 2400.2 of this Appendix) or 60% of the stipend amounts as determined by the Department. 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.
10-144 C.M.R. ch. 101, § III-97-D-2400