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-13 - TARGETED CASE MANAGEMENT SERVICES › Subsection 144-101-II-13.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
13.01-1
An adult
is any person
					 who is eighteen (18) years of age or older or who is a legally emancipated
					 minor. Adults aged eighteen (18) through twenty (20) years of age and children
					 who are emancipated minors may choose to receive children's behavioral health
					 or developmental disabilities services
or
adult behavioral health
					 or developmental disabilities services, whichever best meets their individual
					 needs.
13.01-2
Antibody
is a protein belonging to a class of proteins called
					 immunoglobulins. Antibodies are produced by the body to counteract specific
					 antigens as a response to the infection.
13.01-3
Authorized Agent:
shall
					 mean the organization authorized by the Department of Health and Human Services
					 (DHHS) to perform specified functions pursuant to a signed contract or other
					 approved signed agreement.
13.01-4
Case Management Agencies
are a firm, partnership, association,
					 corporation, or an organization approved to provide case management services by
					 the Department or its Authorized Agent.
In order for these agencies to provide case management
						services they must execute a MaineCare Provider Agreement, and any other
						contract required by the Department of Health and Human Services. They must
						also be able to meet DHHS policy and contract requirements for case management
						services.
13.01-5
Case Management Services
are those covered services provided by a
					 social services or health professional, or other qualified staff, to identify
					 the medical, social, educational and other needs (including housing and
					 transportation) of the eligible member, identify the services necessary to meet
					 those needs, and facilitate access to those services. Case management consists
					 of intake/assessment, plan of care development, coordination/advocacy,
					 monitoring, and evaluation.
13.01-6
Child
is a person between the ages of birth to eighteen (18) years
					 of age. Adults aged eighteen (18) through twenty (20) years of age and children
					 who are emancipated minors may choose to receive children's behavioral health
					 or developmental disabilities services
or
adult behavioral health
					 or developmental disabilities services, whichever best meets their individual
					 needs.
13.01-7
Child and
					 Adolescent Functional Assessment Scale (CAFAS)
is a multi-dimensional
					 rating scale, which assesses a member's degree of impairment in day-to-day
					 functioning due to emotional, behavioral, psychological, psychiatric, or
					 substance use problems.
13.01-8
Child and Adolescent Needs and Strengths (CANS)
assessment is a
					 multipurpose tool that assesses the needs and strengths of children and
					 adolescents with mental illness, developmental disabilities/intellectual
					 disabilities, and autism spectrum disorders. The CANS may be used to support
					 decision making (including level of care and service planning), to facilitate
					 quality improvement initiatives, and to allow for the monitoring of outcomes of
					 services. There are multiple versions of the CANS tool tailored to particular
					 age ranges, including the Child and Adolescent Needs and Strength
					 assessment-Preschool Comprehensive (CANS-PC) (ages 0-5), the Child and
					 Adolescent Needs and Strengths assessment-Mental Health (CANS-MH) (ages 5-17),
					 the Child and Adult Needs and Strengths assessment Transition Mental Health
					 (CANSAT-MH) (ages 18-21), the Child and Adolescent Needs and Strengths
					 assessment Autism Spectrum Profile (ASP) (0-18) and the Child and Adult Needs
					 and Strengths assessment Transition Developmental Disabilities (CANSAT-DD)
					 (18-21).
13.01-9
Child and
					 Family Team
refers to a group of individuals who develop an
					 Individualized Service Plan (ISP) for the eligible child. The team shall
					 consist of the following persons:
a. The
					 eligible child or adolescent, unless clinically contraindicated;
					 and/or
b. The eligible child or
					 adolescent's parent(s) or other legal or designated representative, such as
					 guardian or advocate; and
c. The
					 comprehensive case manager; and
d.
					 at least one (1) of the following individuals:
i. A health/mental health care professional
					 (physician, psychiatrist, psychologist, social worker, nurse, crisis
					 intervention worker, according to the needs of the child or
					 adolescent);
ii. Other key
					 providers, deemed appropriate by the Child and Family Team to address the
					 eligible child or adolescent's specific needs (e.g., child protection or
					 substitute care worker, rehabilitation counselor, physical, speech,
					 occupational or recreational therapist, child development worker, substance
					 abuse counselor, criminal justice worker);
iii. Other persons identified and approved by
					 the family, such as extended family members, neighbors, friends, and others who
					 provide informal support;
iv. A
					 special education or other education professional.