Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 148 - OFFICE OF CHILD AND FAMILY SERVICES › Chapter 5 - PURCHASE OF SERVICE POLICY MANUAL › Section 148-5-II - CONTRACT DEVELOPMENT

Current through 2024-29, July 17, 2024
A.
REFERRAL
				FOR SERVICES
1. PURPOSE:
The Department of Health and Human Services is aware that
				  there are more individuals in need of social services than there are resources
				  to serve them. To ensure that individuals determined to be in need have access
				  to service within the limitation of available funds, the Department identifies
				  priority target groups for federal and state funded services. Individuals
				  served by Department regional social service units and other agencies
				  designated by the Department as its representatives in the community are
				  afforded the highest priority for social services purchased with Office of
				  Child and Family Services funds.
2. STANDARDS OF CONDUCT:
a. The Office of Child and Family Services
				shall stipulate in purchase of service contract agreements the amounts of
				services to be delivered to each category of Department or Area Agency on Aging
				referred priority clients.
b. The
				Office of Child and Family Services shall consider Department or Area Agency on
				Aging individuals as priority clients for purchased services when one or more
				of the following occurs:
i. It is determined
				during the course of the case study that a purchased service is an integral
				part of a case plan to remove or prevent circumstances of abuse or neglect of
				children, or to remove or prevent danger to an incapacitated or dependent
				adult.
ii. It is determined as a
				result of the case study and is part of the case plan that one or more
				particular service(s) is/are an integral part of a case plan:
a. To remedy abuse and neglect to children,
				or danger to an incapacitated or dependent adult;
b. For the parents to be rehabilitated and
				the children to be reunited with their families;
c. To prevent neglect and abuse from
				recurring in a family previously open for protective intervention or to prevent
				danger recurring to an incapacitated or dependent adult;
d. Necessary to accomplish the objective for
				the child and/or his family or adult;
e. Necessary to accomplish the objective for
				an active Family Services participant.
f. Necessary to prevent institutionalization
				of an elderly person; or
g.
				Necessary to accomplish the objective for an active WEET participant.
c. Provider
				organizations shall be required to give priority for those services which are:
1. Integral to accomplishing the objective
				for the child and/or his/her family;
2. Integral to meeting life, health and
				safety needs of the child and/or his family, or an adult, or an elderly person;
				or
3. Integral to the attainment or
				maintenance of employment of a WEET participant.
d. Priority for services for Department and
				Area Agency on Aging referred individuals shall be limited to those services
				consistent with those identified on the formal DHHS referral form, after
				assessment, consultation and agreement.
e. Department regional social services staff
				and Area Agency on Aging Case Managers shall complete and transmit to provider
				organizations formal referral forms on all priority clients in the manner
				prescribed in the Purchase of Service Procedures Manual.
f. Provider organizations shall consider
				Department or Area Agency on Aging referred individuals as priority clients
				only when a formal written referral is received.
g. The assigned Human Services caseworker or
				Area Agency on Aging manager is responsible for the case management of child
				protective, substitute care, adult protective, adult
				guardianship/conservatorship, Family Services, WEET cases and elderly at risk
				clients.
h. The Human Services
				caseworker or Area Agency on Aging manager and provider agency staff shall meet
				at agreed upon intervals to discuss future need for purchased services. Results
				shall be confirmed in writing by the Department of Health and Human Services
				worker, or Area Agency on Aging case manager, filed in the client's record, and
				a copy sent to provider(s) for that agency's client record.
i. Provider organizations shall have the
				right to deny service to priority clients when:
i. Circumstances in the case would constitute
				a danger to the provider organization's staff or other clients;
ii. The services requested are not within the
				provider organization's service description.
iii. The client or the client's guardian
				refuses the service.
iv. The
				services for which the Department contracted are depleted.
j. Provider organizations shall have the
				right to terminate service to priority clients when:
i. The provider organization has not received
				a formal DHHS referral form within ten (10) working days of the initial
				referral after contacting the appropriate DHHS or Area Agency on Aging
				supervisor indicating non-receipt of an appropriate referral.
ii. Circumstances arise in the case which
				constitute a danger to the provider organization's staff or other
				clients.
iii. Referring staff
				informs the provider organization that either the client is no longer eligible
				for priority service or the client is no longer in need of the
				service.
k. Referring
				staff shall review all cases at least every six months to determine eligibility
				in priority status and need for service, and shall notify the appropriate
				provider organizations in writing of the case status.
l. Provider agencies shall be notified by
				Area Agency on Aging Case Managers when the following occur:
i. Immediately, upon determination that a
				client is eligible for services through an alternative fee -for-service
				arrangement that precludes continued payment for services with Office
				funds.
ii. When it has been
				determined that the client is no longer at serious risk of
				institutionalization, the Case Manager shall close the case in accordance with
				Department policy and notify the agency ten (10) calendar days in advance of
				closing.
iii. When the client is
				being institutionalized, the Case Manager shall close the case in accordance
				with Department policy and notify the provider agency ten (10) calendar days in
				advance of closing.
m.
				If, in the judgment of the Department of Health and Human Services worker, the
				WEET participant would not be subjected to loss of employment or training by
				discontinuation of service, the worker shall close the case in accordance with
				Department policy, and notify the agency 10 calendar days in advance of
				closing.
n. Upon notification by
				the Department or Area Agency on Aging that a case is to be closed, the
				provider organization shall initiate the procedures for closing the case from
				referred status as outlined in the Purchase of Service Procedures
				Manual.
o. When the Department
				caseworker determines that continuation of purchased services in a priority
				status is no longer necessary to stabilize the family or adult's situation, the
				caseworker shall notify the provider of the client's loss of priority status
				with 10 calendar days of the determination.
p. When the Department caseworker determines
				that continuation of purchased services in a priority status is necessary to
				stabilize the family or adult's situation, the caseworker shall notify the
				provider(s) of closure as a protective case, with an accompanying referral form
				indicating the need for continued service(s) in post-protective
				status.
q. Purchased services may
				be delivered under post-protective status without regard to income for up to
				three (3) months.