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-23 - Developmental and Behavioral Clinic Services › Subsection 144-101-II-23.04 - COVERED SERVICES

Current through 2024-29, July 17, 2024
The following services are covered when provided by
						Approved Staff Members of a Developmental and Behavioral Evaluation Clinic and
						billed by that clinic. The Foster Care Comprehensive Health Assessment is
						covered when provided by Approved Staff Members or otherwise qualified
						professionals in accordance with this Section.
Covered services must be provided under the direction of
						a physician.
23.04-1
Developmental and Behavioral Evaluation
is a Multidisciplinary
					 Evaluation of social interaction, communication, stereotyped patterns of
					 behavior and includes evaluation of other associated developmental and
					 behavioral problems. The evaluation is conducted by a multidisciplinary team
					 that consists of a Psychiatrist and either a Licensed Psychologist or a
					 Psychological Examiner. If a Licensed Psychologist is not part of the team, the
					 team must also include a Licensed Clinical Social Worker or Licensed Clinical
					 Professional Counselor.
The Developmental and Behavioral Evaluation components
						may include a Psychosocial Assessment, a Psychological Evaluation and testing,
						clinically appropriate interviews and observations scales to assess for Autism
						Spectrum Disorders, and a Psychiatric Evaluation. The Developmental and
						Behavioral Evaluation may, at times, also include, speech/language,
						occupational therapy, and physical therapy assessments.
The Developmental and Behavioral Evaluation team consults
						to summarize the member's functional strengths and limitations to establish
						diagnosis(es) and to prepare recommendations for treatment or service. The
						Developmental and Behavioral Evaluation team communicates its findings to the
						parent or guardian and if clinically appropriate, the member. The findings are
						also summarized in a written report provided to the parent or guardian.
Developmental and Behavioral Evaluations are limited to
						two (2) per member per year. Each Developmental and Behavioral Evaluation is
						limited to fourteen (14) hours/units per evaluation.
23.04-2
Child Abuse Evaluation
means an expert forensic evaluation of a member which is conducted under the
					 direction of a board certified pediatrician who is a trained specialist in
					 child abuse assessment. The purpose of the Child Abuse Evaluation is to
					 evaluate the existence and extent of any child abuse or neglect and the
					 emotional, physical, and behavioral effects of such abuse or neglect. The Child
					 Abuse Evaluation is a multidisciplinary evaluation. The Child Abuse Evaluation
					 must be performed by the following licensed professionals: child abuse
					 pediatrician; nurse practitioner or an equivalent provider; and licensed
					 clinical social worker or an equivalent provider.
The Child Abuse Evaluation must include a detailed
						psychosocial intake including contact with the Department, Law Enforcement, and
						the member's Primary Care Physician (PCP), detailed medical examination as
						appropriate, clinical interview with the member and parent, medical history,
						and psychological testing if necessary, and review of medical records. There
						shall be a final team meeting(s) to determine diagnosis, finalize conclusions
						regarding abuse and neglect and make recommendations regarding care, treatment,
						and safety plans. In addition to aiding in the provision of medically necessary
						services to the member, the purpose of the Child Abuse Evaluation is to produce
						a diagnosis and treatment recommendations that may be introduced into evidence
						in a child protective, criminal, or other court proceeding. Child Abuse
						Evaluations are limited to two (2) per member per year.
The Department shall submit to CMS and anticipates
						approval for a State Plan Amendment for this provision:
23.04-3
Foster Care
					 Comprehensive Health Assessment (CHA)
is a medically based,
					 interdisciplinary comprehensive health evaluation of a child in the
					 Department's care.
A. CHA Provider
					 Requirements
CHAs may be provided within a Developmental and
						Behavioral Evaluation Clinic or by other qualified providers who are not
						practicing in a Developmental and Behavioral Evaluation Clinic.
A Board-certified pediatrician, family physician,
						physician assistant, or pediatric or family nurse practitioner must complete
						the medical exam component of the CHA.
A licensed psychologist, licensed clinical social worker,
						or a licensed clinical professional counselor must complete the psychosocial
						evaluation component of the CHA.
Providers of the CHA must:
1. Be licensed professionals acting within
					 the scope of their licensure;
2.
					 Have at least one (1) year of documented experience providing comprehensive,
					 trauma-informed care for infants, children and adolescents; and
3. Must have at least one (1) year of
					 documented experience in one (1) or more of the following areas:
a. Child abuse, child neglect, and sexual
					 abuse of children;
b. Developmental
					 and behavioral issues of infants, children, and adolescents;
c. Family dynamics and their effects on
					 children; or
d. The effects of
					 foster care placement on children and families.