Items not included above but which have been recommended in a Personal Plan are subject to approval by DHHS for reimbursement. DHHS does not cover those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the member. Adaptations that add to the total square footage of the home are also excluded from this benefit except when necessary to complete an adaptation (e.g. in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). In-floor radiant heating is not allowable. General household repairs are not included in this benefit. All services must be provided in accordance with applicable local, State or Federal building codes. Home Accessibility Adaptations may not be furnished to adapt living arrangements that are owned or leased by providers of waiver services. The limit for adaptations is ten thousand dollars ($10,000) in a five (5) year period, with an additional annual allowance up to three hundred dollars ($300) for repairs and replacement per year. All items in excess of five hundred dollars ($500) require documentation from a physician or other appropriate professionals such as OT, PT or Speech therapists that the purchase is appropriate and medically necessary to meet the member’s need. Medically necessary home modifications that cannot be obtained as a covered service under any other MaineCare benefit may be reimbursed under this section if they meet all requirements of this Section. 21.05-11 Home Support-Agency Per Diem is provided at the provider’s managed service location by a Direct Support Professional to improve and maintain a member’s ability to live as independently as possible. Home Support is direct support to a member and includes primarily habilitative training and/or personal assistance with Activities of Daily Living (ADL) and/or Instrumental Activities of Daily Living (IADL self-care, self-management), development and personal well-being. Agency Home Support is constant daily support that includes personal care, protective oversight, and supervision in accordance with the member’s Personal Plan, depending upon the member’s activities. Payment is not made for the cost of room and board, including the cost of building maintenance, upkeep and improvement. 21.05 COVERED SERVICES (cont.) Payment is not made directly, or indirectly, to the member's immediate family.
Items not included above but which have been recommended in a Personal Plan are subject to approval by DHHS for reimbursement. DHHS does not cover those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the member. Adaptations that add to the total square footage of the home are also excluded from this benefit except when necessary to complete an adaptation (e.g. in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). In-floor radiant heating is not allowable. General household repairs are not included in this benefit. All services must be provided in accordance with applicable local, State or Federal building codes. Home Accessibility Adaptations may not be furnished to adapt living arrangements that are owned or leased by providers of waiver services. The limit for adaptations is ten thousand dollars ($10,000) in a five (5) year period, with an additional annual allowance up to three hundred dollars ($300) for repairs and replacement per year. All items in excess of five hundred dollars ($500) require documentation from a physician or other appropriate professionals such as OT, PT or Speech therapists that the purchase is appropriate and medically necessary to meet the member’s need. Medically necessary home modifications that cannot be obtained as a covered service under any other MaineCare benefit may be reimbursed under this section if they meet all requirements of this Section. 21.05-11 Home Support-Agency Per Diem is provided at the provider’s managed service location by a Direct Support Professional to improve and maintain a member’s ability to live as independently as possible. Home Support is direct support to a member and includes primarily habilitative training and/or personal assistance with Activities of Daily Living (ADL) and/or Instrumental Activities of Daily Living (IADL self-care, self-management), development and personal well-being. Agency Home Support is constant daily support that includes personal care, protective oversight, and supervision in accordance with the member’s Personal Plan, depending upon the member’s activities. Payment is not made for the cost of room and board, including the cost of building maintenance, upkeep and improvement. 21.05 COVERED SERVICES (cont.) Payment is not made directly, or indirectly, to the member's immediate family.
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