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 197-11-04 - COVERED SERVICES

Current through 2024-29, July 17, 2024
Covered services are available for individuals meeting the
				  eligibility requirements set forth in Section 11.02. All covered services
				  require prior authorization by the Department, or its Authorized Agent,
				  consistent with these rules, and are subject to the limits in Section 11.03.
				  The Authorized Plan of Service shall be based upon the consumer's assessment
				  outcome scores recorded on the Department's Medical Eligibility Determination
				  (MED) form, and its definitions.
Services provided must be required for meeting the identified
				  needs of the individual, based upon the outcome scores on the MED form, and as
				  authorized in the plan of service. Coverage will be denied if the services
				  provided are not consistent with the consumer's authorized plan of service. The
				  Department may also recoup payment from the Authorized Agent, pursuant to
				   22 MRSA
				  §1714-A, if applicable, for
				  inappropriate service provision or overpayment, as determined through post
				  payment review.
Covered Services are:
(A)
Administration
Costs of the
				overall administration of this program are built into the hourly rate for
				Personal Assistance Services. The Authorized Agent is responsible for overall
				administration including consumer assessment, monitoring, assistance,
				instruction, and assistant payment processing. Registered Nurses, Occupational
				Therapists and Certified Occupational Therapy Assistants are staff qualified to
				carry out these functions. Such tasks include:
(1) initiating eligibility assessments and
				re-assessments to determine medical eligibility and the consumer's ability to
				self-direct;
(2) determining the
				need for additional non-scheduled reassessments or additional skills
				training;
(3) providing skills
				training and testing;
(4)
				monitoring, through face-to-face contact
,
unless the
				consumer has previous experience with another personal assistance
				program
,
at least twice in the first six (6) months
				and annually thereafter to coincide with reassessment, documenting and taking
				appropriate action concerning any changes in the general health and welfare of
				the consumer;
(5) providing
				consumer instruction services as needed by the individual consumer to
				demonstrate competency in the direction and management of the PA for initially
				instructing the consumer in the management of Personal Assistants and
				additional instruction as needed.
(a) Consumer
				instruction services must be provided to each new eligible consumer prior to
				the start of services. The Authorized Agent must document that the consumer has
				successfully completed the training within thirty (30) calendar days of the
				date of determination of medical eligibility.
(b) Instruction in PA management includes:
				instruction in recruiting, interviewing, selecting, training, scheduling and
				directing a competent assistant in the activities identified in the authorized
				plan of service and if necessary terminating the PA's employment.
(c) Consumer instruction also includes
				instructing the consumer in his or her rights and responsibilities, including
				the obligations under the Consumer Directed Home Based Care policy.
(6) assessing the
				consumer/assistant relationship, including whether assistant duties are being
				performed satisfactorily, whether assistant training is adequate or if
				additional training is needed;
(7)
				issuing a notice of intent to reduce, deny or terminate services as defined in
				Section 11.03.