Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 197 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 10 - CERTIFICATION REQUIREMENTS FOR AGENCIES SEEKING TO PROVIDE COMMUNITY BASED TARGETED CASE MANAGEMENT FOR ADULTS WITH MENTAL RETARDATION AND AUTISM › Section 197-10-II - Definitions

Current through 2024-29, July 17, 2024
ADA: the Americans with Disabilities Act of 1990 (104 Stat
				  327, Pub. L.
				  101-336,
				  42 USC §§
										12101
et seq.
)
Advocate: a representative of the protection and advocacy
				  agency described at
				   5 MRSA §§19501
				  -
				  19509.
Agency: a firm, partnership, association, corporation,
				  organization or trust certified or seeking certification under these
				  regulations.
Assessment: the process of identifying the person's needs
				  through in-person contact with the person and, where appropriate, consultation
				  with other providers and with the person's family and guardian.
Autism: as defined at 34B MRSA § 6002, a developmental
				  disorder characterized by a lack of responsiveness to other people, gross
				  impairment in communicative skills and unusual responses to various aspects of
				  the environment, all usually developing within the first 30 months of
				  age.
Case management services: those services provided by an
				  agency, to identify the medical, social, educational and other needs of the
				  person, identify the services necessary to meet those needs, and facilitate
				  access to those services. Case management consists of plan of care development,
				  coordination/advocacy, monitoring, and evaluation.
Certification: the process whereby an applicant agency is
				  determined to be qualified to provide case management services to adults with
				  mental retardation and autism under the provisions of the MaineCare Manual
				  (10-144 CMR 101), Chapter II, Section 13, Targeted Case Management.
Civil Rights Act: Civil Rights Act of 1964, Pub. L. 88-352,
				  as amended.
Commissioner: the Commissioner of the Department of
				  Behavioral and Developmental Services.
Coordination/Advocacy: the process of facilitating the
				  person's access to the services and resources identified in the plan of care.
				  The case manager may advocate on behalf of the person for appropriate community
				  resources and coordinate the multiple providers of social and health services
				  defined in the plan of care. As part of the coordination function, the case
				  manager will avoid the duplication of services.
Cultural competence: the ability to understand, respect and
				  effectively work with persons/groups with various cultural backgrounds
				  including age and gender.
Department: the Department of Behavioral and Developmental
				  Services.
EEO: the Equal Employment Opportunity Act of 1972 ( Pub. L.
				  92-261 ), as amended.
Eligibility: the process of determining if an individual is
				  eligible for Mental Retardation services according to 34-B MRSA Ch. 5.
Evaluation: the process of determining whether the plan of
				  care is appropriate, whether a new plan is necessary, or whether services
				  should be terminated. Evaluation is accomplished through periodic in-person
				  reassessment of the person, consultation with other providers, and, if
				  appropriate, consultation with the person's family and guardian.
Fee schedule: a document listing the charges for all services
				  available from the service provider.
Governing Body: an individual or association of persons with
				  ultimate managerial control and legal responsibility for the operation of a
				  program or service and for defining the program or service authority and
				  structure. Normally, the Governing Body discharges its responsibilities by
				  employing a chief administrative officer and formulating policies for the
				  agency's authority and structure.
Guardian: individual(s) or agency with ongoing legal
				  responsibility for ensuring the care of a person, appointed pursuant to 18-A
				  MRSA, Article 5, Part 3.
HIPAA: Health Insurance Portability and Accountability Act of
				  1996 ( Pub. L.
				  104-191 ).
Informed consent: consent obtained in writing from a person
				  or the person's legally authorized representative for a specific treatment,
				  intervention or service. Elements of a valid informed consent include
				  information to assist the person to make the consent, including the diagnosis,
				  the nature and purpose of the procedure(s) or service(s) for which consent is
				  sought, all material risks and consequences of the procedure(s) or service(s),
				  an assessment of the likelihood that the procedure(s) or service(s) will
				  accomplish the desired objective(s), any reasonably feasible alternatives for
				  treatment, with the same supporting information as is required regarding the
				  proposed procedure(s) or service(s), and the prognosis if no treatment is
				  provided.
Intake: a process whereby a case manager or qualified intake
				  worker meets with the person, the person's family and the person's guardian if
				  one has been appointed, for the purpose of providing information regarding
				  services, collecting evaluations and diagnoses to determine service
				  eligibility, and conducting an assessment for planning purposes.
MRSA: Maine Revised Statutes Annotated.
Maine Human Rights Act (MHRA):
				   5 MRSA §4551,
et seq.
Mental retardation: as defined at
				   34-B MRSA
				  §5001, a condition of significantly
				  subaverage intellectual functioning resulting in or associated with concurrent
				  impairments in adaptive behavior and manifested during the developmental
				  period.
Monitoring: the process of ensuring that the person's plan of
				  care is implemented and assessing progress towards meeting the objectives
				  outlined in the plan of care. It includes contact with the person as needed to
				  monitor the plan of care objectives and, if appropriate, periodic contact with
				  the person's family and guardian.
PCP: Person Centered Plan.
Person: Adult with mental retardation or autism receiving
				  case management services as defined in this rule.
Person Centered Plan: the personal planning process described
				  in the September 28, 1994, consent agreement of Consumer Advisory Board, et
				  al., v. Glover, et al., Civil No. 91-321-P-C, Section
				  VII.
Plan of Care Development: the process of determining, with
				  the person, and unless inappropriate, the person's family and guardian, and
				  other providers, what services and resources are necessary to meet the
				  identified needs of the person and how such services and resources might be
				  most appropriately delivered. The plan of care is designed to maintain current
				  service delivery and to resolve gaps in services so that comprehensive care is
				  attained. The plan of care development must be consistent with requirements of
				  Person Centered Planning.
Policy: a statement of the principles that guide and govern
				  the activities, procedures, and operations of a program or the provision of
				  services.
Procedure: a series of activities designed to implement the
				  goals or policies of a program.
Provider: an organization or individual providing services to
				  adults with mental retardation or autism, funded in whole or in part,
				  licensed/certified or otherwise authorized by the Department.
Quality management: processes designed to improve the quality
				  of care of services within an organization. Quality management includes quality
				  assurances and quality improvement activities.
Rehabilitation Act: Rehabilitation Act of 1973 (87 Stat. 355,
				  Pub. L. 93-112, 29 USC
				  §701
et seq.
)
Referral: (1) a request for a particular service at an agency
				  or agencies known to provide that service for a specific person by the person,
				  a family member, a guardian or by another entity (such as a health care
				  provider or case management agency) with the permission of the person or
				  guardian if one has been appointed; (2) a transfer of information about a
				  person to another agency for purposes of seeking services from that agency on
				  the person's behalf. Documentation of the referral process and informed consent
				  are required elements of a referral.