Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-18 - RULES GOVERNING IMPLEMENTATION OF THE TRADE ADJUSTMENT ASSISTANCE PROGRAM › Subsection 144-101-II-18.04 - CARE PLAN DEVELOPMENT

Current through 2024-29, July 17, 2024
18.04-1
Procedures for Developing the Care Plan
A member's Care Plan will be developed as part of the
						process of applying to receive services under the waiver. The process for
						applying is as follows:
A. Choice
					 Letter: The process begins by the member signing and submitting a "choice
					 letter" to the Office of Aging and Disability Services (OADS) requesting
					 services under the waiver. The choice letter is a form that DHHS sends to
					 individuals who may be eligible for services under this section requesting that
					 the individual indicate their preference between receiving services in an
					 institutional setting (such as a nursing facility) or receiving services in a
					 community setting under this section.
B. Application: After receiving the choice
					 letter, the DHHS Care Monitor will meet with the member and guardian or power
					 of attorney (where applicable) and complete the initial application
C.
Functional and Medical Assessments:
The Care Monitor will request the MED assessment to be completed by the
					 ASA. The Care Monitor will complete the Mayo Portland Adaptability Inventory
					 (or current functional assessment, as approved by the DHHS) and the Department
					 approved Health and Safety Assessment. The Health and Safety Assessment must
					 have been completed within the past 90 days from the date of application.
D.
Preliminary Care Plan:
The Care Monitor will work with the member and guardian or power of
					 attorney (where applicable) to create a preliminary Care Plan to address all
					 safety/risks needs identified by the Health and Safety Assessment, the MED
					 assessment, and the Mayo Portland Adaptability Inventory (or current functional
					 assessment approved by DHHS). Each safety/risk need identified will require a
					 plan to safely support the member in the community with two forms of back-up
					 support. The member will also select the member's service package and
					 preliminary budget.
E.
Selection of Home Support Option and Development of Final Care
					 Plan:
The final Care Plan must be developed by the member, the Care
					 Monitor,guardian or power of attorney (where applicable) and the Home Support
					 Servicesprovider. The member will work with the Care Monitor, guardian or power
					 of attorney (where applicable) to select an approved Home Support provider as
					 outlined in 18. 05-6. Once the Home Support Services provider is selected, the
					 Home Support provider will assist the member in developing the final Care Plan
					 including the budget and selection of services.
F.
Signatures:
In order for the
					 final Care Plan to be approved, the Care Plan must include signatures of (1)
					 the member, or guardian, where applicable, and (2) the Care Coordinator.
G.
Department Review and
					 Approval:
All services must be Prior Authorized by OADS. Prior to
					 implementation or start of Section 18 Services, the Care Plan must be reviewed
					 and approved by OADS, and OADS must determine that the member is eligible for
					 services as outlined in Section 18. 03-1, 2 and 3.
H.
Utilization Review:
All Care
					 Plans must be reviewed and approved by OADS. DHHS and its Authorized Entity
					 reserve the right to conduct Utilization Review of any service authorized under
					 this Section, applying the service-specific eligibility standards set forth in
					 this Section. DHHS and its Authorized Entity may terminate or revise a service
					 authorization upon finding that the member no longer satisfies the eligibility
					 standards for the service or level of service authorized.