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-26 - Day Health Services › Subsection 144-101-II-26.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
26.01-1
Day Health Services
are
					 health services that are needed to insure the optimal functioning of the member
					 that are provided through a day health service. These services must be provided
					 under an individual plan of care and outside the member's residence.
26.01-2
Day Health Program
is a
					 service that provides day health services and is licensed by the Department of
					 Health and Human Services (DHHS or Department), Bureau of Elder and Adult
					 Services.
26.01-3
Nursing
					 Services
are services provided by a registered nurse and/or a licensed
					 practical nurse within appropriate professional licensing regulations. They
					 include, but are not necessarily limited to, monitoring health problems,
					 monitoring and administering medication, and performing skilled
					 tasks.
26.01-4
Cuing
is any spoken instruction or physical guidance, which serves as a signal to do
					 something. Cuing is typically used when caring for individuals who are
					 cognitively impaired.
26.01-5
Limited Assistance
describes an individual's self-care performance
					 in activities of daily living, as defined by the Minimum Data Set (MDS)
					 assessment process. It means that although the individual was highly involved
					 in the activity over the last seven(7) days, or twenty-four (24) to forty-eight
					 (48) hours if in a hospital setting, help of the following type(s) was
					 provided:
- Guided maneuvering of limbs or other non-weight-bearing
						assistance three (3) or more times, or
- Guided maneuvering of limbs or other
						non-weight-bearing assistance three (3) or more times plus weight-bearing
						support provided only one (1) or two (2) times.
26.01-6
One-person Physical
					 Assist
requires one (1) person to provide either weight-bearing or
					 non-weight-bearing assistance for an individual who could not perform the
					 activity independently in the preceding seven (7) days, or twenty-four (24) to
					 forty-eight (48) hours if in a hospital setting. This does not include cuing.
26.01-7
Extensive Assistance
means although the member performed part of the activity over the last
					 seven (7) days, or twenty-four(24) to forty-eight (48) hours in a hospital
					 setting, help of the following type(s) was provided:
- Weight-bearing support three (3) or more times,
						or
- Full staff performance during part (but not all) of
						the last seven (7) days.
26.01-8
Medical Eligibility
					 Determination (MED) Form
is 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 are outlined in the MED form
					 and provide the basis for services and the care plan. The care plan summary
					 contained in the MED form documents the authorized service plan. The care plan
					 summary also identifies other services the member is receiving, in addition to
					 the authorized services provided under this Section.
26.01-9
Authorized Agent
is the
					 contractor selected by the Department of Health and Human Services to conduct
					 face-to-face assessments and reassessments of member eligibility, using the
					 DHHS Medical Eligibility Determination form, and the time frames and
					 definitions within it, to determine medical eligibility for covered
					 services.
26.01-10
Significant Change
means a major change in the member's status
					 that is not self limiting, affects more than one (1) area of functional health
					 status, and requires a multi-disciplinary review or revision of the authorized
					 plan of care. A self-limiting condition is one that will normally resolve
					 itself within two (2) weeks without further intervention or by staff
					 implementing standard disease related clinical intervention.
26.01-11
Significant Change
					 Assessment
means the process by which the Department or its authorized
					 agent determines whether a member has sustained a Significant Change. A
					 Significant Change Reassessment is appropriate if the member exhibits two (2)
					 or more instances of either improvement or decline that affect the member's
					 physical condition.