Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 149 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 5 - BUREAU OF ELDER AND ADULT SERVICES POLICY MANUAL › Section 149-5-62 - INDEPENDENT HOUSING with SERVICES PROGRAM (IHSP)

Current through 2024-29, July 17, 2024
62.01
DEFINITIONS
(A)
Independent Housing with Services
				Programs
that receive Bureau of Elder and Adult Services funds must meet
				the policy requirements described in this section. The Bureau of Elder and
				Adult Services administers funds to subsidize the cost of services at certain
				sites in compliance with 22 M.R.S.A. Chapter 1664. This section pertains only
				to Independent Housing with Services Programs that meet the definition in 22
				M.R.S.A. Chapter 1644. Provision of these services is based on the availability
				of funds.
(B)
Activities of
				daily living (ADLs)
ADLs shall only include the following as defined in
				Section 62.02(B)(2): bed mobility, transfer, locomotion, eating, toileting,
				bathing and dressing.
(C)
An
				Independent Housing with Services Program grantee
is an Independent
				Housing with Services Program sponsor that receives funds through a written
				agreement with the Bureau of Elder and Adult Services
(D)
An Independent Housing with
				Services Program sponsor
is an individual, agency, organization or
				business operating an Independent Housing with Services Program that meets the
				requirements described in this section.
(E)
Authorized Agent
means an
				organization authorized by the Department to perform functions under a valid
				contract or other approved, signed agreement. The Independent Housing with
				Services grantee is the Authorized Agent under this section.
(F)
Authorized Plan of Care
means a plan of care which is authorized by the Authorized Agent or the
				Department, which shall specify all services to be delivered to a recipient
				under this section, including the number of hours for all covered services. The
				plan of care shall be based on the recipient's assessment outcome scores, and
				the timeframes contained therein, recorded in the Department's Medical
				Eligibility Determination (MED) form. All authorized covered services provided
				under this Section must be listed in the care plan summary on the MED
				form.
(G)
Care Plan
				Summary
is the section of the MED form that documents the Authorized
				Plan of Care and 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)
Covered Services
are those
				services for which payment can be made by the Department under Section 62 of
				the Bureau of Elder and Adult Services Policy Manual.
(I)
Cueing.
Cueing means any
				spoken instruction or physical guidance, which serves as a signal to do
				something. Cueing is typically used when caring for individuals who are
				cognitively impaired.
(J)
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, TANF Standard of Need Chart. 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.
(K)
Disability-related expenses
: Disability-related expenses are
				out-of-pocket costs incurred by the consumers 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, show 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: lab 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; and
(9) Medical
				insurance premiums, co-pays and deductibles.
(L)
Household members:
means the
				consumer and spouse.
(M)
Household members Income
includes:
(1) Wages from work, including payroll
				deductions, excluding state and Federal taxes and employer mandated or court
				ordered withholdings;
(2) Benefits
				from Social Security, Supplemental Security Insurance, pensions, insurance,
				independent retirement plans, annuities, and Aid and Attendance;
(3) Adjusted gross income from property
				and/or business, based on the consumer's most recent Federal income tax;
				and
(4) Interest and dividends.
Not included are benefits from: the Home Energy Assistance
				  Program, Food Stamps, General Assistance, Property Tax and Rent Refund,
				  emergency assistance programs, or their successors.
(N)
Independent Housing with
				Services
means residential housing that consists of private dwelling
				units with an individual bathroom and an individual food preparation area, in
				addition to central dining facilities, and within which an assisted housing
				supportive services program serves occupants as described in
				22 M.R.S.A. §
											7852(3).
(O)
Independent Housing with Services
				Program
means a comprehensive program of supportive services, serving
				three or more consumers at a site, including meals, housekeeping and chore
				assistance, service coordination/care management, personal care services,
				emergency response and other services that are delivered on the site of an
				Independent Housing and Services Program, assist occupants to manage the
				activities of daily living and the instrumental activities of daily living as
				defined in Section 62.02(B)(3)
(P)
Instrumental activities of daily living (IADLs)
For purposes of
				the eligibility criteria and covered services under this section of policy,
				IADLS are limited to the following: preparation or receipt of the main meal;
				routine housework; grocery shopping and storage of purchased groceries; and
				laundry either within the residence or at an outside laundry facility; and
				transportation services necessary to perform covered services described in the
				consumer's Authorized Service Plan.
(Q)
Limited Assistance
means the
				individual was highly involved in the activity over the past seven days, or 24
				to 48 hours if in a hospital setting, but received and required
* guided maneuvering of limbs or other non-weight bearing
				  physical assistance three or more times or
* guided maneuvering of limbs or other non-weight bearing
				  physical assistance three or more times plus weight-bearing support provided
				  only one or two times.
(R)
Liquid asset
is something of value available to the consumer that
				can be converted to cash in three months or less and includes:
(1) Bank accounts;
(2) Certificates of deposit;
(3) Money market and mutual funds;
(4) Life insurance policies;
(5) Stocks and bonds;
(6) Lump sum payments and inheritances;
				and
(7) Funds from a home equity
				conversion mortgage that are in the consumer's possession whether they are cash
				or have been converted to another form.
Funds which are available to the consumer but carry a penalty
				  for early withdrawal will be counted minus the penalty. Exempt from this
				  category are mortuary trusts and lump sum payments received from insurance
				  settlements or annuities or other such assets named specifically to provide
				  income as a replacement for earned income. The income from these payments will
				  be counted as income.
(S)
Medical Eligibility Determination
				(MED) Form
shall mean the form approved by the Department for medical
				eligibility determinations and service authorization for the plan of care based
				upon the assessment outcome scores. The definitions, scoring mechanisms and
				time-frames relating to this form as defined in Section 62 provide the basis
				for services and the care plan authorized by the Authorized Agent. The care
				plan summary contained in the MED form documents the authorized service plan to
				be implemented by the Independent Housing with Services Provider. The care plan
				summary also identifies other services the recipient is receiving, in addition
				to the authorized services provided under this Section.
(T)
One-person Physical Assist
requires one person over the last seven (7) days or 24-48 hours if in a
				hospital setting, to provide either weight-bearing or non-weight bearing
				assistance for an individual who cannot perform the activity independently.
				This does not include cueing.
(U)
Personal care assistance.
"Personal care assistance" means
				assistance with the activities of daily living and the instrumental activities
				of daily living. "Personal care assistance" does not include the administration
				of medication.
(V)
Private
				apartment.
"Private apartment" means a private dwelling unit with an
				individual bathroom and an individual food preparation area located within an
				Independent Housing with Services Program.
(W) An
authorization for services
included in a consumer's plan of care is a written statement of the
				level, type, frequency, duration and number of units of service to be provided
				to each consumer on a monthly basis.