Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 197 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 11 - CONSUMER-DIRECTED PERSONAL ASSISTANCE SERVICES › Section 197-11-01 - DEFINITIONS

Current through 2024-29, July 17, 2024
(A)
Consumer-Directed Personal
				Assistance Services
program, hereinafter referred to as
Consumer-Directed Home Based Care (CDHBC),
is a state funded program to
				provide long term care services to assist eligible consumer's to avoid or delay
				inappropriate institutionalization. State funds furnished through 34-B M.R.S.A.
				§5438 may not be used to supplant the resources available from families,
				neighbors, agencies and/or the consumer or from other Federal, State programs
				unless specifically provided for elsewhere in this section. State CDHBC funds
				shall be used to purchase only those covered services that are essential to
				assist the consumer to avoid or delay inappropriate institutionalization and
				which will foster independence, consistent with the consumer's circumstances
				and the authorized plan of service.
(B)
Activities of daily living
				(ADLs)
ADLs include the following as defined in Section 11.02(B)(1)(a):
				bed mobility, transfer, locomotion, eating, toileting, bathing, hygiene, and
				dressing. The list of ADLs may be modified by the Authorized Agent, with the
				approval of the Department.
(C)
Assessing Services Agency (ASA)
ASA means an organization
				authorized through a written agreement with the Department to conduct
				face-to-face assessments, using the Department's Medical Eligibility
				Determination (MED) form, and the timeframes and definitions contained therein,
				to determine medical eligibility and need for covered services. Based upon a
				consumer's assessment outcome scores recorded in the MED form, the ASA is
				responsible for authorizing a plan of service, which shall specify all services
				to be provided under this Section, including the number of hours for services,
				and the Authorized Agent types. The ASA is the Department's Authorized Agent
				for medical eligibility determinations and service plan development, and
				authorization of covered services as allowed under this Section.
(D)
Authorized Agent
means an
				organization authorized by the Department under a valid contract or other
				approved, signed agreement to conduct a range of activities, which includes
				some or all of the following: accept referrals; assess consumer service needs;
				monitor the implementation of the service plan; train the consumer; serve as a
				resource to consumer's and their families; and assist with resolving problems.
				The Authorized Agent is also responsible for administrative functions,
				including maintaining consumer records; processing claims; final determination
				of the consumer copayment on receipt of the required information and collection
				of consumer co-payments; conducting the functions of an employer of record; and
				conducting required utilization review activities.
(E)
Authorized Plan of Service
				is
a plan of service that is determined by the Assessing Services
				Agency, or the Department, and that specifies all services to be delivered to a
				consumer as allowed under this Section, including the number of hours for all
				covered services under this section. The Authorized Plan of Serviceshall be
				based upon the consumer's assessment outcome scores, and the timeframes
				contained therein, recorded in the Department's medical eligibility
				determination (MED) form. The Authorized Plan of Servicemust be completed on
				the Department's MED form and must not exceed the services required to provide
				necessary assistance with ADLs, IADLs, and identified Health Maintenance
				Activities on the MED form. The Authorized Agent has the authority to determine
				and authorize the plan of service. All authorized covered services provided
				under this Section must be listed in service Plan summary on the MED form. The
				Authorized Plan of Servicemust reflect the needs identified by the assessment,
				giving consideration to the consumer's living arrangement, informal supports,
				and services provided by other possible public or private funding sources to
				ensure non duplication of services. In no case will the amount of service
				authorized exceed the Maximum Authorized Service amount established by the
				Department. In the event the Maximum Authorized Service amount is amended, all
				Authorized Plans of Service will immediately be amended to reflect the amended
				Maximum.
(F)
Department
means the Department of Health and Human Services.
(G)
Service Plan Summary
is the
				section of the MED form that documents the Authorized Plan of Serviceand
				services provided by other public or private program funding sources or
				support, service category, reason codes, duration, unit code, number of units
				per month, rate per unit, and total cost per month.
(H)
Cognitive capacity:
The
				consumer must have the cognitive capacity to perform all of the tasks and
				responsibilities of an employer in order to competently direct and manage the
				assistant. The consumer's cognitive capacity will be determined by an
				assessment conducted by the Authorized Agent.
(I)
Complete Medical Eligibility
				Determination packet
includes a signed release of information, the fully
				completed medical eligibility determination (MED) form, the eligibility
				notification, hearing and appeal rights, service plan, complete financial
				assessment. Packets submitted that do not meet Department specifications will
				be returned to the AA.
(J)
Consumer
, is the individual qualified for the program who will direct
				and control the Personal Assistant (PA). The consumer is someone with a
				disability who has functional limitations, which interfere with self-care and
				activities of daily living. The consumer must have the cognitive capacity to
				competently direct and manage the assistant on the job in order to assist
				and/or perform the ADLs, IADLs, and health maintenance activities. The consumer
				must be determined eligible for services under this section.
(K)
Consumer-Directed Home Based Care
				Services
, also known as Personal Assistance Services (PAS), or
				Assistance Services, enable eligible people with disabilities to re-enter or
				remain in the community and to maximize their independent living opportunity at
				home. Consumer Directed Home Based Care Services includes a range of assistance
				with Activities of Daily Living (ADL), Instrumental Activities of Daily Living
				and Health Maintenance activities. The eligible consumer hires his/her own
				assistant, trains the assistant, supervises the provision of covered services,
				completes the necessary written documentation, and if necessary, terminates
				services or directs the termination of the assistant. The Department or the
				Assessing Services Agency, consistent with these rules, shall determine medical
				eligibility for services under this Section, prior authorize all covered
				services as allowed under this section, and authorize a plan of service for
				each new and established consumer of services.
(L)
Covered Services
are those
				services for which payment can be made by the Department, under these
				regulations.
(M)
Criminal
				Background Check
is research into the history of a PA or potential PA to
				determine if there is any criminal conviction involving abuse, neglect or
				misappropriation of property in a health care setting, or a complaint involving
				abuse or neglect that was substantiated by the Department pursuant to its
				responsibility to license hospitals, nursing facilities, home health agencies
				and assisted housing programs and that was entered on the Maine Registry of
				Certified Nursing Assistants, or a complaint involving the misappropriation of
				property in a health care setting that was substantiated by the Department and
				entered on the Maine Registry of Certified Nursing Assistants.
(N)
Department
means the Maine
				Department of Health and Human Services.
(O)
Dependent Allowances.
Dependents and dependent allowances are defined and determined in
				agreement with the method used in the MaineCare program. The allowances are
				changed periodically and cited in the MaineCare Eligibility Manual, Chart II,
				AFDC Related Income Limits. Dependents are defined as individuals who may be
				claimed for tax purposes under the Internal Revenue Code and may include a
				minor or dependent child, dependent parents, or dependent siblings of the
				consumer or consumer's spouse. A spouse may not be included.
(P)
Disability-related expenses
:
				Disability-related expenses are out-of-pocket costs incurred by the consumer's
				for their disability, which are not reimbursed by any third-party sources. They
				include:
(1) Home access modifications: ramps,
				tub/shower modifications and accessories, power door openers, shower
				seat/chair, grab bars, door widening, environmental controls;
(2) Communication devices: adaptations to
				computers, speaker telephone, TTY, Personal Emergency Response
				Systems;
(3) Wheelchair (manual or
				power) accessories: lap tray, seats and back supports;
(4) Vehicle adaptations: adapted carrier and
				loading devices, one communication device for emergencies (limited to purchase
				and installation), adapted equipment for driving;
(5) Hearing Aids, glasses, adapted visual
				aids;
(6) Assistive animals
				(purchase only);
(7) Physician
				ordered medical services and supplies;
(8) Physician ordered prescription and over
				the counter drugs;
(9) Medical
				insurance premiums, co-pays and deductibles;
(10) Unemployment and workers compensation
				expenses related to employing the PA: and
(11) The actual paid costs of conducting
				criminal background checks