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-17 - Community Support Services › Subsection 144-101-II-17.04 - COVERED SERVICES

Current through 2024-29, July 17, 2024
The following are covered services reimbursable under
						MaineCare. All services delivered will ensure that member voice and choice are
						reflected in all Plan development:
17.04-1
Community Integration
					 Services
. Community Integration Services includes a biopsychological
					 assessment of the member, an evaluation of community services and natural
					 supports needed by the member who satisfies the eligibility requirements of
					 Section
					 17.02, and rapport
					 building through assertive engagement and linking to necessary natural supports
					 and community services while providing ongoing assessment of the efficacy of
					 those services.
Community Integration Services involve active
						participation by the member or guardian. The services also involve active
						participation by the member's family or significant other, unless their
						participation is not feasible or is contrary to the wishes of the member or
						guardian. These services are provided as indicated on the ISP. These services
						may not be provided in a group.
A Community Support Provider furnishing Community
						Integration Services must employ a certified MHRT/C who performs the
						following:
A. Identifies the medical,
					 social, residential, educational, vocational, emotional, and other related
					 needs of the member;
B. Performs a
					 psychosocial assessment, including history of trauma and abuse, history of
					 substance use, general health, medication needs, self-care potential, general
					 capabilities, available support systems, living situation, employment status
					 and skills, training needs, and other relevant capabilities and
					 needs;
C. Facilitate formal and
					 informal opportunities for career exploration during service delivery time for
					 working-age and transition age youth participants;
D. Provides assertive, persistent engagement
					 to build rapport and trust with individuals who may be reluctant to accept
					 those services necessary to meet their individual goals;
E. Develops an ISP that is based on the
					 results of the assessment in Section 17.04-1(B), which includes:
1. Statements of the member's desired goals
					 and related treatment and rehabilitation goal(s);
2. A description of the service(s) and
					 natural support(s) needed by the member to address the goal(s);
3. A statement for each goal of the frequency
					 and duration of the needed service(s) and support(s);
4. The identification of providers of the
					 needed service(s) and natural support(s);
5. The identification and documentation of
					 the member's unmet needs;
6. A
					 review of the plan at least every ninety (90) days to determine the efficacy of
					 the services and natural supports and to formulate changes in the plan as
					 necessary; and
7. A goal addressing
					 the member's needs and access to primary care, specialty care, and routine
					 appointments.
F.
					 Coordinates referrals and advocates access by the member to the service(s) and
					 natural support(s) identified in his or her Individual Support Plan;
G. Participates in ensuring the delivery of
					 crisis intervention and resolution services, providing follow-up services to
					 ensure that a crisis is resolved and assistance in the development and
					 implementation of crisis management plans;
H. Assists in the exploration of less
					 restrictive alternatives to hospitalization;
I. Makes face-to-face contact with other
					 professionals, caregivers, or individuals included in the treatment plan in
					 order to achieve continuity of care, coordination of services, and the most
					 appropriate services for the member per their ISP;
J. Contacts the member's guardian, family,
					 significant other, and providers of services or natural supports to ensure the
					 continuity of care and coordination of services between inpatient and community
					 settings;
K. Evaluates service
					 provision to determine whether the member's ISP needs to be revised, whether a
					 new plan is needed, or whether services should be terminated;
L. Provides information and consultation with
					 the member receiving Community Support Services, to the member, his or her
					 family, or his or her immediate support system, in order to assist the member
					 to manage the symptoms or impairments of his or her illness with a focus on
					 independence;
M. Assists the member
					 in restoring and improving - communication skills needed to request assistance
					 or clarification from supervisors and co-workers when needed and in -enhancing
					 skills and employing strategies to overcome or address psychiatric symptoms
					 that interfere with seeking, obtaining, and maintaining a job; and
N. Documents evidence of the member's access
					 to primary and specialty care appointments, to minimally include an annual
					 primary care provider visit. This can be in the form of a clinical note or
					 after visit summary.