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-18 - RULES GOVERNING IMPLEMENTATION OF THE TRADE ADJUSTMENT ASSISTANCE PROGRAM › Subsection 144-101-II-18.03 - DETERMINATION OF ELIGIBILITY

Current through 2024-29, July 17, 2024
18. 03-1
Approved Opening
The number of MaineCare members who can receive services
						under this section is limited to the number of openings approved by the Centers
						for Medicare and Medicaid Services (CMS). Persons who would otherwise be
						eligible for services under this section are not eligible to receive services
						if all of the approved openings are filled.
18. 03-2
General Eligibility
					 Criteria
Consistent with Subsection 18. 03-1, a person is eligible
						for services under this section if the person:
A. Is age eighteen (18) or older;
					 and
B. Has a diagnosis of acquired
					 brain injury. Acquired Brain Injury means an insult to the brain resulting
					 directly or indirectly from trauma, anoxia, or vascular lesions, or infection,
					 which is not of a degenerative or congenital nature, can produce a diminished
					 or altered state of consciousness resulting in impairment of cognitive
					 abilities and/or physical functioning, can result in the disturbance of
					 behavioral or emotional functioning, can be either temporary or permanent, and
					 can cause partial or total functional disability or psychosocial maladjustment.
					 (Title 22 §3086); and
C. The
					 individual has received an assessment by a qualified neuropsychologist (as
					 defined in the MaineCare Benefits Manual, Rehabilitative Services, Section 102.
					 08-5 B) and/or a licensed physician who is Board certified or Board eligible in
					 Physical Medicine and Rehabilitation, which:
1. positively indicates the individual: is
					 not in a persistent vegetative state; is able to demonstrate potential for
					 physical and/or behavioral and/or cognitive rehabilitation; shows evidence of
					 moderate to severe behavioral and/or cognitive and/or functional disabilities;
					 and
2. results in specific
					 rehabilitation goals, based upon the findings of the assessment, describing
					 types and frequencies of therapies and expected outcomes and time frames; and
D. Has a completed
					 Department-approved Health and Safety Assessment administered by the Department
					 with an overall score of 0. 1 or higher. The Department approved Health and
					 Safety Assessment evaluates cognitive, physical, and behavioral needs related
					 to a person's brain injury. It assesses whether a person needs support for the
					 three areas. Additionally, it assesses if the person needs cueing, direct
					 support, or a behavioral support. Scores range from 0-1. The assessment can be
					 found at the Department's Brain Injury Services website:
http://www.
					 maine. gov/dhhs/oads/disability/bi/index. shtml
The assessment was last
					 revised: 02/25/14. The Department will only accept assessments conducted no
					 more than three months prior to application; and
E. Has completed Mayo-Portland Adaptability
					 Inventory - 4 (or current Department approved version of the MPAI) with an item
					 score of 3 or higher for two of the following items:
a. Novel Problem Solving
b. Impaired Self-Awareness
c. Irritability, Anger, Aggression
d. Inappropriate Social Interaction
e. Fund of Information or
					 Attention/Concentration or Memory
The Department will only accept assessments conducted no
						more than three months prior toapplication; and
F. Does not receive services under any other
					 federally-approved MaineCare home and community-based waiver program;
					 and
G. Meets all MaineCare
					 eligibility requirements as set forth in the MaineCare Eligibility Manual;
					 and
H. The estimated annual cost of
					 the member's services under the waiver is equal to or less than one hundred
					 percent (100%) of a blended rate of the statewide average annual cost of care
					 for individuals in Intermediate Care Facilities for Individuals with
					 Intellectual Disabilities (ICFs/IID) and Nursing Facility Brain Injury units,
					 as determined by DHHS (the blended rate being the sum of 20% of the statewide
					 average annual cost of care in an ICF/IID and 80% of the statewide average
					 annual cost of care in a Nursing Facility Brain Injury unit); and
I. Can have his or her health and welfare
					 needs assured in the community setting as stated in § 18. 04-2(D).