4.05 NON-COVERED SERVICES AND LIMITATIONS (cont.) Personal care aide (PCA) services provided Chapter II, Section 96 of the MCBM, Duty Nursing and Personal Care Services”; “Private Pharmacy services for prescribed drugs provided under Chapter II, Section 80 of the MCBM, Services”; “Pharmacy Assistive Technology services provided under the following Sections of the MaineCare Benefits Manual: a. Chapter II, Section 18, and Community Based Services for “Home Adults with Brain Injury”; b. Chapter II, Section 19, and Community Benefits for the Elderly “Home and for Adults with Disabilities”; c. Chapter II, Section 20, and Community-Based Services for “Home Adults with Other Related Conditions”; d. Chapter II, Section 21, and Community Benefits for Members “Home with Intellectual Disabilities or Autistic Disorder”; d. Chapter II, Section 29, Services for Adults with Intellectual “Support Disabilities or Autistic Disorder”; and e. Chapter II, Section 32, Services for Children with Intellectual “Waiver Disabilities or Pervasive Developmental Disorders”. Non–Emergency Medical Transportation services provided under Chapter II, Section 113 of the MBM, Transportation (NET) Services”; “Non-Emergency Ambulance services provided under Chapter II, Section 5 of the MBM, Services”; “Ambulance Services that require direct physical contact with a Member by a Health Care Provider and that cannot be delegated to another Health Care Provider at the site where the Member is located are not covered; Any service medically inappropriate for delivery through Telehealth Services. C. Reimbursement will not be provided for communications between Health Care Providers when the Member is not present at the Originating (Member) Site. D. Reimbursement will not be provided for communications solely between Health Care Providers and Members when such communications not otherwise be billable. E. The Originating Facility Fee may only be billed in the event that the Originating (Member) Site is in a Healthcare Provider’s facility. F. The Originating Site Fee may be paid only to a Health Care Provider. 4.06 POLICIES AND PROCEDURES
4.05 NON-COVERED SERVICES AND LIMITATIONS (cont.) Personal care aide (PCA) services provided Chapter II, Section 96 of the MCBM, “Private Duty Nursing and Personal Care Services”; Pharmacy services for prescribed drugs provided under Chapter II, Section 80 of the MCBM, “Pharmacy Services”; Assistive Technology services provided under the following Sections of the MaineCare Benefits Manual: a. Chapter II, Section 18, “Home and Community Based Services for Adults with Brain Injury”; b. Chapter II, Section 19, “Home and Community Benefits for the Elderly and for Adults with Disabilities”; c. Chapter II, Section 20, “Home and Community-Based Services for Adults with Other Related Conditions”; d. Chapter II, Section 21, “Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder”; d. Chapter II, Section 29, “Support Services for Adults with Intellectual Disabilities or Autistic Disorder”; and e. Chapter II, Section 32, “Waiver Services for Children with Intellectual Disabilities or Pervasive Developmental Disorders”. Non–Emergency Medical Transportation services provided under Chapter II, Section 113 of the MBM, “Non-Emergency Transportation (NET) Services”; Ambulance services provided under Chapter II, Section 5 of the MBM, “Ambulance Services”; Services that require direct physical contact with a Member by a Health Care Provider and that cannot be delegated to another Health Care Provider at the site where the Member is located are not covered; Any service medically inappropriate for delivery through Telehealth Services. C. Reimbursement will not be provided for communications between Health Care Providers when the Member is not present at the Originating (Member) Site. D. Reimbursement will not be provided for communications solely between Health Care Providers and Members when such communications not otherwise be billable. E. The Originating Facility Fee may only be billed in the event that the Originating (Member) Site is in a Healthcare Provider’s facility. F. The Originating Site Fee may be paid only to a Health Care Provider. 4.06 POLICIES AND PROCEDURES
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