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-102.08 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
102.08-1
Rehabilitative Services
In order for services to be reimbursable, a service must
						meet the following standards:
The provider must be accredited by the Rehabilitation
						Accreditation Commission (CARF) to provide brain injury rehabilitation services
						(other than vocational services, which are not covered by MaineCare,) or
						otherwise have an eighteen (18)-month provisional certification from the Maine
						Department of Health and Human Services to cover the period the provider is
						working to secure CARF accreditation. The Department is responsible for
						determining compliance with the provisional certification standards in Appendix
						I of this Section. A copy of the Department issued provisional certification,
						or evidence of current CARF accreditation, must be on file with the MaineCare
						Services. Additionally, the provider must also supply the Department with a
						copy of the current CARF accreditation survey and if applicable, any plans of
						corrections.
Providers must maintain CARF accreditation to receive
						MaineCare reimbursement. CARF accreditation is for a specified period of time
						and requires periodic review and approval. To maintain accreditation beyond the
						expiration date, a provider must be resurveyed by CARF by the expiration date
						or be in the process of a resurvey by the expiration date. Evidence that the
						resurvey visit has been scheduled can indicate that the resurvey process is
						underway, as long as the visit was scheduled prior to the expiration date.
						MaineCare reimbursement will be subject to recoupment, back to the day on which
						accreditation expired, if CARF accreditation is denied. The facility must
						provide to the office listed below written evidence of the scheduled CARF
						survey visit. Evidence of current CARF accreditation, upon receipt, must also
						be submitted to this office:
Provider File Unit
MaineCare Services
11 State House Station
Augusta, ME 04333-0011
AND
Office of Adults with Cognitive and Physical
						Disabilities-Brain Injury Services
11 State House Station
Augusta, ME 04333-0011
Each provider must have a written agreement for services
						with a clinical director, or shall employ a physician, a neuropsychologist, and
						other professional personnel to assure appropriate supervision, medical review,
						and approval of services provided. The clinical director must have
						responsibility for the overall management of the service and have two (2) years
						experience in the rehabilitation of individuals with brain injury, as well as
						have management and specific training that will enable the director to
						understand and respond to the unique needs of individuals with brain injuries.
						The clinical director must be actively involved in the service and provide
						oversight for day-to-day operations.
If a Provider plans to add a new BI service component
						that will require additional CARF accreditation (CARF requires new services to
						be delivered for at least six (6) months prior to a survey visit), the provider
						may receive MaineCare reimbursement for these new services while working toward
						CARF survey and certification, so long as the Department is notified in writing
						at least two (2) months in advance of the intent to seek CARF certification and
						the date services will start. Additionally, the CARF survey visit must be
						scheduled prior to the end of the six (6)-month period, i.e. a survey visit
						must be scheduled, not necessarily completed, and the Department notified in
						writing of the CARF survey appointment date. Reimbursement for the new service
						component will be subject to recoupment, back to start date of the new
						services, if CARF accreditation is denied.
102.08-2
Setting
These services are intended to be provided on an
						outpatient basis. However, services may, in some instances, be provided in Home
						and Community settings if the treatment plan addresses the medical necessity
						for the member to receive services outside of the outpatient setting. All
						facilities providing rehabilitative services must be accessible to people with
						disabilities, in accordance with Section 504 of the Rehabilitation Act of 1973,
						as amended (
						29 USC, Section
						794 ), and the Americans with Disabilities
						Act of 1990, ( 42 USC, 1281 et seq.).
102.08-3
Start of Care
A. The provider must notify the Department of
					 a member's start of care (SOC) date, which is the first billable day of
					 service. The SOC and UR Form must be submitted to the Department prior to
					 reimbursement. All services must be prior authorized by the Department or its
					 Authorized Agent.
Providers must submit some or all of the following
						documents to the Department or its Authorized Agent:
1. Start of Care and Utilization
					 Form;
2. A completed Brain Injury
					 Assessment Tool, which must include the Eligibility Scoring pages that indicate
					 the actual number of service hours per week the member is anticipated to
					 receive for his or her specific eligibility level;
3. A copy of the completed Clinical
					 Assessment and health and safety assessment; and
4. A copy of the individual treatment
					 plan.