Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 149 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 5 - BUREAU OF ELDER AND ADULT SERVICES POLICY MANUAL › Section 149-5-61 - ADULT DAY SERVICES

Current through 2024-29, July 17, 2024
61.01
DEFINITIONS.
(A)
Adult Day
				Services
means an appropriately licensed program that receives funding
				assistance from Bureau of Elder and Adult Services for consumers who require
				assistance in paying for this service.
(B)
Activities of daily living
				(ADLs)
ADLs shall only include the following as defined in Section
				61.02: bed mobility, transfer, locomotion, eating, toileting, bathing and
				dressing
(C)
Authorized
				Agent
means an organization authorized by the Department to perform
				reimbursable functions as specified in this section. The Licensed Adult Day
				Service provider is the Authorized Agent under this Section.
(D)
Authorized Service plan
				means
a plan which is authorized by the Adult Day Service provider, or
				the Department, which shall specify all services to be delivered to a recipient
				under this Section, including the number of hours for all covered services. The
				service plan shall be based upon the recipient's assessment outcome scores and
				the timeframes contained therein, recorded in the Department's medical
				eligibility determination (MED) form. The Adult Day Services provider has the
				authority to determine and authorize the service plan. All authorized covered
				services provided under this Section must be listed in the care plan summary on
				the MED form.
(E)
Care Plan
				Summary
is the section of the MED form that documents the Authorized
				Service Plan and services provided by other public or private program funding
				sources or support, service category, reason codes, duration, unit code, number
				of units per month, rate per unit, and total cost per month.
(F)
Covered Services are
those
				services for which payment can be made by the Department, under Section 61 of
				the Bureau of Elder and Adult Services policy manual.
(G)
Cueing
shall mean any spoken
				instruction or physical guidance, which serves as a signal to do something.
				Cueing is typically used when caring for individuals who are cognitively
				impaired.
(H)
Dependent
				Allowances.
Dependents and dependent allowances are defined and
				determined in agreement with the method used in the MaineCare program. The
				allowances are changed periodically and cited in the MaineCare Eligibility
				Manual, TANF Standard of Need Chart. Dependents are defined as individuals who
				may be claimed for tax purposes under the Internal Revenue Code and may include
				a minor or dependent child, dependent parents, or dependent siblings of the
				consumer or consumer's spouse. A spouse may not be included.
(I)
Disability-related expenses
: Disability-related expenses are out-of-pocket costs incurred by the consumers
				for their disability, which are not reimbursed by any third-party sources. They
				include:
(1) Home access modifications:
				ramps, tub/shower modifications and accessories, power door openers, show
				seat/chair, grab bars, door widening, environmental controls;
(2) Communication devices: adaptations to
				computers, speaker telephone, TTY, Personal Emergency Response
				Systems;
(3) Wheelchair (manual or
				power) accessories: lab tray, seats and back supports;
(4) Vehicle adaptations: adapted carrier and
				loading devices, one communication device for emergencies (limited to purchase
				and installation), adapted equipment for driving;
(5) Hearing Aids, glasses, adapted visual
				aids;
(6) Assistive animals
				(purchase only);
(7) Physician
				ordered medical services and supplies;
(8) Physician ordered prescription and over
				the counter drugs; and
(9) Medical
				insurance premiums, co-pays and deductibles.
(J)
Household members:
means the
				consumer and spouse
(K)
Household members' income
includes:
(1) Wages from work, including payroll
				deductions, excluding state and Federal taxes and employer mandated or court
				ordered with holdings;
(2) Benefits
				from Social Security, Supplemental Security Insurance, pensions, insurance,
				independent retirement plans, annuities, and Aid and Attendance;
(3) Adjusted gross income from property
				and/or business, based on the consumer's most recent Federal income tax;
				and
(4) Interest and dividends.
Not included are benefits from: the Home Energy Assistance
				  Program, Food Stamps, General Assistance, Property Tax and Rent Refund,
				  emergency assistance programs, or their successors.
(L)
Limited Assistance
means the
				individual was highly involved in the activity over the past seven days, or 24
				to 48 hours if in a hospital setting, but received and required
* guided maneuvering of limbs or other non-weight bearing
				  physical assistance three or more times or
* guided maneuvering of limbs or other non-weight bearing
				  physical assistance three or more times plus weight-bearing support provided
				  only one or two times
(M)
Liquid asset
is something of value available to the consumer that
				can be converted to cash in three months or less and includes:
(1) Bank accounts;
(2) Certificates of deposit;
(3) Money market and mutual funds;
(4) Life insurance policies;
(5) Stocks and bonds;
(6) Lump sum payments and inheritances;
				and
(7) Funds from a home equity
				conversion mortgage that are in the consumer's possession whether they are cash
				or have been converted to another form.
Funds which are available to the consumer but carry a penalty
				  for early withdrawal will be counted minus the penalty. Exempt from this
				  category are mortuary trusts and lump sum payments received from insurance
				  settlements or annuities or other such assets named specifically to provide
				  income as a replacement for earned income. The income from these payments will
				  be counted as income.
(N)
Medical Eligibility Determination
				(MED) Form
shall mean the form approved by the Department for medical
				eligibility determinations and service authorization for the service plan based
				upon the assessment outcome scores. The definitions, scoring mechanisms and
				time frames relating to this form as defined in Section 61 provide the basis
				for authorized services and the service plan by the Adult Day Services
				provider. The care plan summary contained in the MED form documents the
				authorized service plan to be implemented by the Adult Day Services provider in
				the service plan. The service plan summary also identifies other services the
				recipient is receiving, in addition to the authorized services provided under
				this Section.
(O)
One-person
				Physical Assist
requires one person over last seven (7) days or 24-48
				hours if in a hospital setting, to provide either weight-bearing or non-weight
				bearing assistance for an individual who cannot perform the activity
				independently. This does not include cueing.