reglab/statecodes huggingface dataset:
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-18.08 - DURATION OF CARE

Current through 2024-29, July 17, 2024
18. 08-1
Voluntary Termination
- A member who currently receives the benefit, but
					 no longer wants to receive the benefit, will be terminated from waiver
					 services, after DHHS receives written notice from the member that he or she no
					 longer wants the benefit.
18. 08-2
Involuntary Termination
- DHHS will give written notice of
					 termination from waiver services to a member at least thirty (30) days prior to
					 the effective date of the termination, providing the reason for the
					 termination, and the member's right to appeal such decision. A member may be
					 terminated from this benefit for any of the reasons listed below:
A. The member has been determined to be
					 financially or medically ineligible for this benefit;
B. The member has been determined to be a
					 nursing facility resident or ICF/IID resident without an approved Care Plan to
					 return to his or her home;
C. The
					 member has been determined to be receiving MaineCare services from another Home
					 and Community Based Waiver benefit;
D. The member is no longer a resident of the
					 State of Maine;
E. The health and
					 welfare of the member can no longer be assured because:
1. The member or immediate family, guardian
					 or caregiver refuses to participate in Care Planning or abide by the Care Plan
					 or other benefit policies;
2. The
					 home or home environment of the member becomes unsafe to the extent that
					 benefit services cannot be provided without risk of harm or injury to the
					 member or to individuals providing covered services to the member; or
3. There is no approved Care Plan.
F. The member has not
					 received at least one service in a consecutive thirty (30) day period;
G. 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).
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-18.09 - RECORDS

Current through 2024-29, July 17, 2024
Each provider serving the member must maintain records
						for each member it serves in accordance with the requirements of Chapter I of
						the MaineCare Benefits Manual. The member's records are subject to DHHS's
						review.
The member's records must contain:
A. The member's name, address, birth date,
					 and MaineCare identification number;
B. The member's social and medical history,
					 and diagnoses;
C. The member's Care
					 Plan;
D. The member's most recent
					 Mayo Portland Adaptability Index;
E. A summary of authorized services;
					 and
F. Written progress notes that
					 identify any progress toward the achievement of the goals, identify activities
					 and identify needs established by the member's Care Plan. Written progress
					 notes must be signed and dated by the staff performing the service.
The provider must document each service provided
						including: the date of each service, the type of service, the activity, the
						need or goal to which the service relates, the length of time of the service,
						and the signature of the individual performing the service.
DHHS will conduct a review of provider records that may
						include, but is not limited to, staff schedules, payroll records and member
						records to substantiate service delivery and units of authorization.
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-18.10 - PROVIDER QUALIFICATIONS AND REQUIREMENTS

Current through 2024-29, July 17, 2024
To provide services under this section a provider must be
						a qualified vendor as approved by DHHS and enrolled by the MaineCare program.
						Once a provider has been authorized to provide services, the provider cannot
						terminate the member's services without written authorization from DHHS.
						Written documentation of all certifications, and licensure requirements and
						date of hire must be contained in a personnel file.
In order for services to be reimbursable, a Provider must
						meet the following standards:
18.10-1
Assistive Technology Services
-In order to provide Assistive
					 Technology Services, a provider must be an OADS-approved agency and the
					 individual providing the services must meet one of the following training
					 requirements:
A. A Licensed Occupational
					 Therapist licensed under MRSA title 32, ch. 32; or
B. A Licensed Speech Pathologist licensed
					 under MRSA title 32, ch. 137; or
C. A certified Direct Support Professional
					 (DSP) as detailed in 18. 10-5 who is also certified as a Rehabilitation
					 Engineering Technologist (RET) or an Assistive Technology Professional
					 (ATP)from the Rehabilitation Engineering and Assistive Technology Society of
					 North America (RESNA).
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-18.12 - APPEALS

Current through 2024-29, July 17, 2024
In accordance with Chapter I of the MaineCare Benefits
						Manual, members have the right to appeal in writing or orally any decision made
						by DHHS to reduce, deny or terminate services provided under this benefit.
The appeal must be (a) requested in writing and mailed to
						the address below, or (b) requested by telephone by calling Local:
						207-287-6598, Toll Free: 1-800-606-0215 or TTY: 711.
Office of Aging and Disability Services
Department of Health and Human Services
11 State House Station
Augusta, ME 04333-0011
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-18.13 - REIMBURSEMENT

Current through 2024-29, July 17, 2024
Reimbursement methodology for covered services shall be
						the amount listed in Chapter III, Section 18, "Allowances for Home and
						Community Based Services for Adults with Brain Injury" or the provider's usual
						and customary charge, whichever is lower.
In accordance with Chapter I, it is the responsibility of
						the provider to seek payment from any other insurance, including Medicare that
						is available for payment of the rendered service prior to billing MaineCare.
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-18.14 - BILLING INSTRUCTIONS

Current through 2024-29, July 17, 2024
Providers must bill in accordance with DHHS's Billing
						Instructions.
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-18.15 - QUALITY REPORTING

Current through 2024-29, July 17, 2024
In order to assure quality of care within the waiver
						services, DHHS requires providers to comply with all quality reporting
						requests. DHHS will develop and release a standard reporting form, which
						providers will be asked to complete and submit at regular intervals. At a
						minimum, the report will include the following information and supporting
						documentation:
A.
The Care
					 Plan
: The provider must track and report data and documentation
					 sufficient to establish that:
1. The
					 provider's services are meeting each member's personal goals;
2. The provider's services are meeting health
					 and safety needs;
3. Each member is
					 receiving all services outlined in the Care Plan;
4. Freedom of choice is offered both for
					 services and provider selection; and
5. The Care Plan is reviewed and approved on
					 an annual basis.
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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.05 - NON-COVERED SERVICES

Current through 2024-29, July 17, 2024
The following services are non-covered services:
A.  Services that are not in the Authorized
					 Plan of Care according to Section
					 19.04, except as
					 allowed under an acute/emergency episode (see Section 19.04-4(A)(13)
					 );
B.  Services that are described
					 as non-covered services in Chapter I of the
MaineCare Benefits
					 Manual
including but not limited to recreational, custodial and
					 leisure activities;
C.  Household
					 tasks, except included as IADL services in the Authorized Plan of Care,
					 according to Section
					 19.04;
D.  Respite services and or IADL tasks when
					 delivered by the member's spouse;
E.
					  Attendant Services provided by a spouse of the member, or by the
					 parents or stepparents of a minor child who is a member;
F.  Personal Care Services provided by the
					 parents or stepparents of a minor child who is a member;
G.  Services provided by anyone prohibited
					 from employment due to criminal background checks or annotations on the Maine
					 Registry of Certified Nursing Assistants and Direct Care Workers as set forth
					 in this Section;
H.  Custodial care
					 or supervision;
I.  Personal care
					 services delivered in a licensed or unlicensed assisted housing setting,
					 including a residential care facility;
J.
					  Room and board and food (except when allowed as part of Home
					 Delivered Meals or as part of Respite Services delivered in the NF
					 setting);
K.  Services provided not
					 in the presence of the member unless in the provision of covered IADLs, such as
					 grocery shopping or laundry while the member remains at home;
L.  Services provided when the member is in
					 the hospital, nursing facility, PNMI, or ICF-IID;
M.  Supervisory visits for HHAs, CNAs, and
					 PSSs;
N.  Services in excess of
					 forty (40) hours per week provided by an individual worker to any individual
					 member or household except as indicated in 19.06-M.
O.  Services provided out of state except as
					 otherwise specifically allowed under this Section or as authorized under
					 Chapter I of the
MaineCare Benefits Manual
; and
P.  Personal care or Attendant Services
					 provided to a member receiving respite in an institutional setting because
					 personal care is the responsibility of that provider.
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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.08 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
19.08-1
Home
					 Delivered Meals:
a provider must meet the following criteria:
1.  be a qualified vendor as approved by DHHS
					 and enrolled by the MaineCare program;
2.
					  be a licensed eating establishment by the State of Maine and meet
					 the requirements of Maine DHHS-Centers for Disease Control, Environmental
					 Health Division and local municipalities;
3.
					  have a Maine-licensed dietician on staff or available on a
					 consultant basis;
4.  be able to
					 provide meals to meet participating members' special dietary needs;
5.  be able to produce and deliver meals to
					 members' homes; and
6.  be able to
					 provide up to one meal per day, seven (7) days per week to eligible members.
					 This includes meals that are either hot, cold, shelf stable or frozen.
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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.09 - CONFIDENTIALITY

Current through 2024-29, July 17, 2024
The disclosure of information regarding MaineCare members
						is strictly limited to purposes directly connected with the administration of
						the MaineCare program. Providers shall maintain the confidentiality of
						information regarding MaineCare members in accordance with 42 C. F. R. 431.
						300-431. 307.
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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.10 - REIMBURSEMENT

Current through 2024-29, July 17, 2024
Reimbursement for covered services shall be the lowest
						of:
A.  The amount listed in Chapter
					 III, Section
					 19, "Allowances for Home and
					 Community Benefits for the Elderly and Adults with Disabilities" for members
					 authorized for these services;
B. 
					 The servicing provider's usual and customary charge; or
C.  The fee negotiated between the Waiver
					 Services Provider and providers contracted for Environmental Modifications.
In accordance with Chapter I, it is the responsibility of
						the provider to seek payment from any other resources (private or group
						insurance benefits, Workers' Compensation, Medicare, etc. ) that are available
						for payment of a rendered service prior to billing MaineCare. Therefore, a
						service provider under these HCB is expected to seek payment from sources other
						than MaineCare that may be available to the member. Providers should document
						all efforts to collect from a third party.
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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities › Subsection 144-101-II-19.11 - BILLING INSTRUCTIONS

Current through 2024-29, July 17, 2024
Billing must be accomplished in accordance with the
						Billing Instructions and procedure codes in Chapter III.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.01 - INTRODUCTION

Current through 2024-29, July 17, 2024
This benefit is a Home and Community Based Waiver for
						Adults with Other Related Conditions (ORC) who are 21 or older, meet
						institutional level of care and choose to live in the community with the
						support of this waiver. This Home and Community Based Waiver is designed to
						maximize the opportunity for members to achieve the greatest degree of
						self-sufficiency and independence chosen by the member. Member choice in all
						services and components of services is a primary goal of this waiver.
						Additionally, the principles of conflict-free care coordination, services
						provided in the least restrictive modality and effective use of assistive
						technology for communication, environmental control and safety are inherent to
						this waiver.
This benefit has been designed and will be implemented in
						such a manner so as to ensure that every waiver service setting:
* Is integrated in and supports full access to the
						greater community;
* Is selected by the member from among setting options;
* Ensures members' rights of privacy, dignity and
						respect, and freedom from coercion and restraint;
* Optimizes autonomy and independence in making life
						choices; and
* Facilitates choice regarding services and who provides
						them.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.05 - COVERED SERVICES

Current through 2024-29, July 17, 2024
20.05-1
Assistive Technology Device and Services
-Assistive technology
					 device means an item, piece of equipment, or product system, whether acquired
					 commercially, modified, or customized, that is used to increase, maintain, or
					 improve functional capabilities of members. Assistive Technology service means
					 a service that directly assists a member in the selection, acquisition, or use
					 of an Assistive Technology device. Assistive Technology includes:
(A) the evaluation of the Assistive
					 Technology needs of a member, including a functional evaluation of the impact
					 of the provision of appropriate Assistive Technology Devices and appropriate
					 Assistive Technology Services to the member in the customary environment of the
					 member;
(B) services consisting of
					 purchasing, leasing, or otherwise providing for the acquisition of Assistive
					 Technology Devices for members;
(C)
					 services consisting of selecting, designing, fitting, customizing, adapting,
					 applying, maintaining/upkeep, repairing, or replacing Assistive Technology
					 Devices;
(D) coordination and use
					 of necessary therapies, interventions, or services with Assistive Technology
					 Devices, such as therapies, interventions, or services associated with other
					 services in the Care Plan;
(E)
					 training or technical assistance for the member, or, where appropriate, the
					 family members, guardians, advocates, or authorized representatives of the
					 member;
(F) training or technical
					 assistance for professionals or other individuals who provide services to,
					 employ, or are otherwise substantially involved in the major life functions of
					 members; and
(G) transmission of
					 data required for use of the Assistive Technology Device via internet or cable
					 utility.
The components above are subject to the following
						limits:
* The Assistive Technology Device and services described
						above in paragraphs (B) and (C) are subject to a combined limit of $6,000.00
						annually.
* The services described above in paragraphs (A), (D),
						(E) and (F) are subject to a combined limit of 32 units (8 hours)
						annually.
* The data transmission utility costs described above in
						paragraph (G) are limited to $50.00 per month.
Assistive Technology Services excludes services available
						under the State Plan.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.08 - DURATION OF CARE

Current through 2024-29, July 17, 2024
20.08-1
Voluntary Termination
- A member who currently receives the
					 benefit, but no longer wants to receive the benefit, will be terminated from
					 waiver services, after DHHS receives written notice from the member that he or
					 she no longer wants the benefit.
20.08-2
Involuntary
					 Termination
-DHHS will give written notice of termination from waiver
					 services to a member at least thirty (30) days prior to the effective date of
					 the termination, providing the reason for the termination, and the member's
					 right to appeal such decision. A member may be terminated from this benefit for
					 any of the reasons listed below:
A. The
					 member has been determined to be financially or medically ineligible for this
					 benefit;
B. The member has been
					 determined to be a nursing facility resident or ICF/IID resident without an
					 approved Care Plan to return to his or her home;
C. The member has been determined to be
					 receiving MaineCare services from another Home and Community Based Waiver
					 benefit;
D. The member is no longer
					 a resident of the State of Maine;
E. The health and welfare of the member can
					 no longer be assured because:
1. The member
					 or immediate family, guardian or caregiver refuses to participate in Care
					 Planning or abide by the Care Plan or other benefit policies;
2. The home or home environment of the member
					 becomes unsafe to the extent that benefit services cannot be provided without
					 risk of harm or injury to the member or to individuals providing covered
					 services to the member; or
3. There
					 is no approved Care Plan.
F. The member has not received at least one
					 service in a consecutive thirty (30) day period;
G. The annual cost of the member's services
					 under this waiver exceeds one hundred percent (100%) of the state-wide average
					 annual cost of care for an individual in an Intermediate Care Facility for
					 Individuals with Intellectual Disabilities (ICF/IID), as determined by DHHS.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.09 - RECORDS

Current through 2024-29, July 17, 2024
Each provider serving the member must maintain records
						for each member it serves in accordance with the requirements of Chapter I of
						the
MaineCare Benefits Manual
. The member's records are
						subject to DHHS's review.
The member's records must contain:
20.09-1 The member's name, address, birth
					 date, and MaineCare identification number;
20.09-2 The member's social and medical
					 history, and diagnoses;
20.09-3 The
					 member's Care Plan;
20.09-4 A
					 summary of authorized services; and
20.09-5 Written progress notes that identify
					 any progress toward the achievement of the goals, identify activities and
					 identify needs established by the member's Care Plan. Written progress notes
					 must be signed and dated by the staff performing the service.
The provider must document each service provided
						including; the date of each service, the type of service, the activity, the
						need or goal to which the service relates, the length of time of the service,
						and the signature of the individual performing the service.
DHHS will conduct a review of provider records that may
						include, but is not limited to, staff schedules, payroll records and member
						records to substantiate service delivery and units of
						authorization.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.10 - PROVIDER QUALIFICATIONS AND REQUIREMENTS

Current through 2024-29, July 17, 2024
To provide services under this section a provider must be
						a qualified vendor as approved by DHHS and enrolled by the MaineCare program.
						Once a provider has been authorized to provide services, the provider cannot
						terminate the member's services without written authorization from DHHS.
20.10-1
Assistive Technology
					 Services
-In order to provide Assistive Technology Services, a provider
					 must be an OADS approved agency and employ:
A. A Licensed Occupational Therapist;
					 or
B. A Licensed Speech
					 Pathologist; or
C. A certified
					 Direct Support Professional (DSP) who is also certified as a Rehabilitation
					 Engineering Technologist (RET) or an Assistive Technology Professional
					 (ATP).
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.11 - APPEALS

Current through 2024-29, July 17, 2024
In accordance with Chapter I of the
MaineCare
						Benefits Manual
, members have the right to appeal in writing or orally
						any decision made by DHHS to reduce, deny or terminate services provided under
						this benefit. The right to appeal does not extend to changes in law or policy
						adversely affecting some or all recipients. The appeal must be (a) requested in
						writing and mailed to the address below, or (b) requested by telephone by
						calling Local: 207-287-6598, Toll Free: 1-800-606-0215 or TTY: 711.
Office of Aging and Disability Services
Department of Health and Human Services
11 State House Station
Augusta, ME 04333-0011
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.12 - REIMBURSEMENT

Current through 2024-29, July 17, 2024
Reimbursement methodology for covered services shall be
						the amount listed in Chapter III, Section 20, Allowances for Home and Community
						Based Services for Adults with Other Related Conditions or the provider's usual
						and customary charge, whichever is lower. In accordance with Chapter I, it is
						the responsibility of the provider to seek payment from any other insurance,
						including Medicare that is available for payment of the rendered service prior
						to billing MaineCare.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.13 - BILLING INSTRUCTIONS

Current through 2024-29, July 17, 2024
Providers must bill in accordance with DHHS's Billing
						Instructions.
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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.14 - QUALITY REPORTING

Current through 2024-29, July 17, 2024
In order to assure quality of care within the ORC waiver
						services, DHHS requires providers to comply with all quality reporting
						requests. The report shall include:
A.
					 The Care Plan
1. Meeting member's personal
					 goals
2. Meeting health and safety
					 needs
3. Member receiving services
					 outlined in the Care Plan
4.
					 Freedom of choice is offered both for services and provider selection
5. Reviewed and Approved on an annual
					 basis
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.01 - INTRODUCTION

Current through 2024-29, July 17, 2024
The Home and Community Benefit (HCB or Benefit) for
						Members with Intellectual Disabilities (ID) or Autism Spectrum Disorder (ASD)
						gives Members eligible for this Benefit the option to live in their own home or
						in another home in the community thus avoiding or delaying institutional
						services. The Benefit is offered in a community-based setting as an alternative
						for Members who qualify to live in an Intermediate Care Facility for
						Individuals with Intellectual Disabilities (ICF/IID). The Benefit supplements,
						rather than replaces supportive, natural personal, family, work, and community
						relationships. It does not duplicate other MaineCare services.
The HCB Benefit is a Home and Community-Based Service
						provided under a Federal 1915(c) waiver that meets Federal standards. MaineCare
						Members may receive covered services as detailed in other sections of the
MaineCare Benefits Manual
, but can receive services under only
						one Home and Community Based waiver at any one time.
In addition, the planning process includes identifying
						and documenting the Member's needs in a Person-Centered Service Plan (PCSP).
						The PCSP describes certain facilitative, therapeutic and intervention services
						and supplies with an overall goal of community inclusion.
The Benefit is a limited one. Each year the Department
						of Health and Human Services (DHHS) must identify the total number of
						unduplicated Members to whom it will provide the benefit during that year. If
						there is no funded opening, or if a Member is not eligible for a funded opening
						based on priority, the Member is placed on a waiting list as described in this
						rule.
This rule does not alter or supplant other sections of
						Maine statute, regulation, or DHHS policy.
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.02 - DEFINITIONS

Current through 2024-29, July 17, 2024
21.02-1
Abuse
means the
					 infliction of injury, unreasonable confinement, intimidation or cruel
					 punishment that causes or is likely to cause physical harm or pain or mental
					 anguish; sexual abuse or sexual exploitation; or the intentional, knowing or
					 reckless deprivation of essential needs as defined in
					 22 MRSA
					 §3472.
21.02-2
Activities of Daily Living
					 (ADLs)
is a term used to collectively describe fundamental skills that
					 are required to independently care for oneself including:
A.
Bed Mobility
: How a person
					 moves to and from lying position, turns side to side, and positions body while
					 in bed;
B.
Transfer
:
					 How a person moves between surfaces to/from: bed, wheelchair, standing position
					 (excluding to/from bath/toilet);
C.
Locomotion
: How a person moves between locations, in room and
					 other areas. If in wheelchair, self-sufficiency once in chair;
D.
Eating
: How a person eats and
					 drinks (regardless of skill);
E.
Toilet Use
: How a person uses the toilet room (or commode, bedpan,
					 urinal), transfers on/off toilet, cleanses, changes pad, manages ostomy or
					 catheter, adjusts clothes;
F.
Bathing
: How a person takes full-body bath/shower, sponge bath and
					 transfers in/out of tub/shower (exclude washing of back and hair);
					 and
G.
Dressing
: How a
					 person puts on, fastens, and takes off all items of street clothing, including
					 donning/removing prosthesis.
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.05 - COVERED SERVICES

Current through 2024-29, July 17, 2024
21.05-1
Home
					 and Community Based Settings
Each home and community-based setting must comply with
						the requirements of the Global HCBS Waiver Person-Centered Planning and
						Settings Rule ("Global HCBS Rule"),
MaineCare Benefits Manual
,
						Chapter 1, Section 6.
In addition, the following additional settings
						requirements apply to Community Support Services, and Work Support Group
						services:
1. Members are allowed to
					 have visitors at these service settings, so long as the Member's PCSP provides
					 for visitors, and so long as the Provider approves each of the visitors. The
					 PCSP must state that the Provider will not charge for additional reimbursement
					 for the visitors: and
2. Members
					 may have visitors at the Employment Setting comparable to the standards related
					 to visitors for any other non HCBS employee that is employed in the
					 business.
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.08 - DURATION OF CARE

Current through 2024-29, July 17, 2024
21.08-1
Voluntary Termination-
A Member who currently receives the
					 benefit, but no longer wants to receive the benefit will be terminated, after
					 DHHS receives written notice from the Member that he or she no longer wants the
					 benefit.
21.08-2
Involuntary
					 Termination-
DHHS will give written notice of termination to a Member at
					 least ten (10) days prior to the effective date of the termination, providing
					 the reason for the termination, and the Member's right to appeal such decision.
					 A Member may be terminated from this benefit for any of the reasons listed
					 below:
A. The Member is determined to be
					 financially or medically ineligible for this benefit or MaineCare;
B. The Member is determined to be a nursing
					 facility resident, ICF/IID, psychiatric hospital, or hospital resident for six
					 months;
C. The Member is determined
					 to be receiving MaineCare services from another Home and Community Based Waiver
					 benefit;
D. The Member is no longer
					 a resident of the State of Maine;
E. The health and welfare of the Member can
					 no longer be assured because:
1. The Member or
					 immediate family, guardian or caregiver refuses to abide by the Person-Centered
					 Service Plan or other benefit policies;
2. The home or home environment of the Member
					 becomes unsafe to the extent that benefit services cannot be provided without
					 risk of harm or injury to the Member or to individuals providing covered
					 services to the Member; or
3. There
					 is no approved Person-Centered Service Plan.
F. The Member has not received at least one
					 waiver service in a thirty (30) day period; or
G. The annual cost of the Member's services
					 under this waiver exceeds two hundred percent (200%) of the state-wide average
					 annual cost of care for an individual in an Intermediate Care Facility for
					 Individuals with Intellectual Disabilities (ICF/IID), as determined by the
					 DHHS, unless the Member is authorized to exceed this limit pursuant to the
					 Exceptions process in this rule and/or another ADA modification.
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.09 - MEMBER RECORDS

Current through 2024-29, July 17, 2024
Each provider serving the Member must maintain a specific
						record for each Member it serves in accordance with the requirements of Chapter
						I of the
MaineCare Benefits Manual
. The Member's record is
						subject to DHHS's review.
In addition, the Member's records must contain:
21.09-1 The Member's name, address, birth
					 date, MaineCare identification number, guardian contacts, if applicable, and
					 emergency contacts;
21.09-2 The
					 Member's social and medical history, including any allergies, and
					 diagnoses;
21.09-3 The Member's
					 Person-Centered Service Plan; and
21.09-4 Written progress notes that identify
					 actions related to the progress toward the achievement of the goals, activities
					 and needs established by the Member's Person-Centered Service Plan signed by
					 the staff performing the service.
DHHS will conduct a review of provider records that may
						include, but is not limited to, staff schedules, payroll records and Member
						records to substantiate service delivery and units of authorization.
All providers must document each service provided, the
						date of each service, the type of service, the activity, need or goal to which
						the service relates, the length of time of the service, and the signature of
						the individual performing the service.
If services are provided by two (2) or more staff working
						different shifts, then each shift must be documented separately.
Example: A Member receives twenty-four hour (24) coverage
						from three (3) staff members working Monday through Friday in eight (8) hour
						shifts, and one (1) staff member that covers the weekend. The provider must
						have documentation for each eight (8) hour shift per day.
If Crisis Intervention is required, a separate progress
						note must be included in the Member's record. The documentation must describe
						the crisis services provided, the date in which the crisis service was
						provided, the length of the crisis service, and the signature of the individual
						performing the crisis service.
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.10 - PROVIDER QUALIFICATIONS AND REQUIREMENTS

Current through 2024-29, July 17, 2024
To provide services under this section a provider must be
						a Qualified Vendor as approved by OADS and enrolled by the MaineCare program.
						Once a provider has been authorized to provide services, the provider cannot
						terminate the Member's services without written authorization from OADS.
						providers must ensure staff are trained in identifying risks, such as risk of
						abuse, neglect, or exploitation; participating in a Member's risk assessment;
						identifying and reporting to an immediate supervisor changes in health status
						and behavior; anticipating or preventing unsafe or destructive behavior; and
						safely intervening against undesirable behavior according to an intervention
						plan. Any intervention must be consistent with the DHHS's rule governing
						Behavioral Support, Modification and Management for People with Intellectual
						Disabilities or Autism (14-197 C.M.R. ch 5). It may also be necessary to seek
						emergency medical or safety assistance when needed and comply with reporting
						requirements outlined in DHHS's Reportable Events System (14-197 C.M.R. ch 12)
						and/or Adult Protective Services System (10-149 C.M.R. ch 1).
21.10-1
Direct Support Professional
					 (DSP)
The following requirements apply to DSPs:
A. DSPs must successfully complete the Direct
					 Support Professional curriculum as adopted by DHHS, or demonstrated proficiency
					 through DHHS's approved Assessment of Prior Learning, or has successfully
					 completed the Maine College of Direct Support within six (6) months of date of
					 hire.
a. Prior to providing services to a
					 Member alone, a DSP must complete the following four modules from the College
					 of Direct Support, including computer based and live sessions:
1. Introduction to Developmental
					 Disabilities
2.
					 Professionalism
3. Individual
					 Rights and Choice
4. Maltreatment
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.11 - APPEALS

Current through 2024-29, July 17, 2024
In accordance with Chapter I of the
MaineCare
						Benefits Manual
, Members have the right to appeal in writing or orally
						any decision made by DHHS to reduce, deny or terminate services provided under
						this benefit. In addition, Members have the right to appeal decisions made
						regarding priority level and waitlist determinations. The right to appeal does
						not extend to changes in law or policy adversely affecting some or all
						recipients. The appeal must be (a) requested in writing and mailed to the
						address below, or (b) requested by telephone by calling Local: 207-287-6598,
						Toll Free: 1-800-606-0215 or TTY: 711.
Office of Aging and Disability Services
Department of Health and Human Services
11 State House Station
Augusta, ME 04333-0011
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.12 - REIMBURSEMENT

Current through 2024-29, July 17, 2024
A. Reimbursement methodology for covered
					 services shall be the amount listed in Chapter III, Section
					 21, Allowances for Home and
					 Community Benefits for Members with Intellectual Disabilities or Autism
					 Spectrum Disorder or the provider's usual and customary charge, whichever is
					 lower.
B. Compliance to the
					 authorization is determined if the average of actual delivered services fall
					 within the range established for that setting or Member. If the average falls
					 within the range, then billing at the approved level is authorized. If the
					 average falls below the pre-set level, then billing must reflect the lower
					 level of service provided.
C. In
					 accordance with Chapter I, it is the responsibility of the provider to seek
					 payment from any other resources that are available for payment of the rendered
					 service prior to billing MaineCare. Therefore, a service provider under this
					 benefit is expected to seek payment from sources other than MaineCare that may
					 be available to the Member.
D.
					 Providers of Community Support Services and Work Support-Group services will
					 not be reimbursed for any times the Member is away from the Provider's setting,
					 without being accompanied by a Provider staff member. The Provider must keep
					 detailed and accurate accounting (by 15-minute increments) of when the Member
					 is in the Provider setting, and receiving the service.
E. Providers of Community Support Services
					 and Work Support-Group will not charge additional reimbursement for any
					 Visitors by the Member.
F. DHHS
					 will conduct a review of provider records that may include, but is not limited
					 to, staff schedules, payroll records and Member records, to substantiate
					 service delivery and units of authorization.
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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder › Subsection 144-101-II-21.13 - BILLING INSTRUCTIONS

Current through 2024-29, July 17, 2024
Providers must bill in accordance with DHHS's Billing
						Instructions.