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-102 - Rehabilitative Services › Subsection 144-101-II-102.02 - DEFINITIONS

Current through 2024-29, July 17, 2024
102.02-1
Authorized Agent
is an
					 organization authorized by the Department to perform functions under a valid
					 contract or other approved signed agreement.
102.02-2
Brain Injury
is an
					 insult to the brain resulting directly or indirectly from trauma, infection,
					 anoxia, or vascular lesions, and not of a degenerative or congenital nature,
					 but which may produce a diminished or altered state of consciousness resulting
					 in impairment of cognitive abilities and/or physical functioning. It can also
					 result in the disturbance of behavioral or emotional functioning. These
					 impairments may be either temporary or permanent and cause partial or total
					 functional disability or psychosocial maladjustment. This does not include
					 brain injuries that are induced by birth.
102.02-3
CARF
is the Commission
					 on Accreditation of Rehabilitation Facilities.
102.02-4
Collateral Contact
is a
					 direct (face-to-face) contact on behalf of the member by a provider to obtain
					 information from, or discuss the member's case with, other professionals,
					 caregivers, or others included in the treatment plan in order to achieve
					 continuity of care, coordination of services, and the appropriate services for
					 the member. Discussions or meetings among staff employed by a single provider
					 on behalf of the member are not to be considered collateral contacts, and are
					 not a billable service.
102.02-5
Family
is a person with a demonstrated family relationship to a
					 member with Brain Injury whose Brain Injury has led to challenging behaviors.
					 For the purposes of this section, family may include only the following;
					 parents, spouse, siblings, children, legal guardian, caregiver, significant
					 other of the member with Brain Injury or the significant other's children.
102.02-6
Functionally
					 Significant Improvement
is the demonstrable measurable increase in the
					 member's ability to perform specific tasks or motions that contribute to
					 independence outside the therapeutic environment.
102.02-7
Individualized Treatment or
					 Service Plan
is a person centered plan of rehabilitative care based on
					 an individual assessment made by a professional or other qualified staff of a
					 member's medical and social needs with specific functional and measurable goals
					 and objectives , authorized by the Department, or the Department's Authorized
					 Agent, at the discretion of the Department.
102.02-8
Intensive Rehabilitation
					 Nursing Facility (NF) Services for Individuals with a
Brain Injury
means services that are
						delivered in a part of a NF and reimbursed a special rate pursuant to Chapter
						III, Section 67, Principles of Reimbursement for Nursing Facilities, Intensive
						Rehabilitation NF Services for Brain Injured Individuals.
102.02-9
Rehabilitation
					 Potential
is the documented expectation of measurable, functionally
					 significant improvement in the member's condition in a reasonable, predictable
					 period of time as the result of the prescribed treatment plan, as determined by
					 a qualified professional. The documentation of rehabilitation potential must
					 include the clinical justification used for this expectation.
102.02-10
Rehabilitative
					 Provider
is a distinct organizational entity in a distinct physical
					 setting, which provides coordinated and integrated services that include
					 evaluation and treatment related to the member's functional limitations and the
					 member's response to treatment. Members may require some services in the home
					 and community away from the provider's physical setting in order to obtain
					 optimal level of functioning. The services are designed to prevent and/or
					 minimize chronic disabilities while restoring the member to the optimal level
					 of physical, cognitive, and behavioral function within the context of the
					 person, family, and the community. The services are highly specialized to
					 address unique service needs of the individual, and designed to prevent
					 deterioration and maintain an optimal level of function over time.
102.02-11
Rehabilitative
					 Services
are those covered services provided under the direction of a
					 neuropsychologist or physician and delivered by a neuropsychologist, physician,
					 occupational therapist, physical therapist, registered nurse, speech-language
					 pathologist, or other qualified staff meeting the qualifications identified in
					 Section 102.08-5.
102.02-12
Significant Change/Relapse
is indicated when the member's score on
					 the Department's authorized brain injury assessment tool increases from the
					 most recent score to a score of at least three (3) on one (1) item, in two (2)
					 or more domains.