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-21.04 - PERSONAL PLAN

Current through 2024-29, July 17, 2024
The Person-Centered Service Plan (PCSP), and the planning
						for the PCSP, 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.
If the Member or guardian chooses services under this
						Section, the request for services must be submitted to DHHS or its Authorized
						Entity. As part of the planning process, the Member's needs are identified and
						documented in the Person-Centered Service Plan.
Except for residential services, other services shall be
						provided to the Member within ninety (90) days of the completed execution of a
						service agreement or amended service agreement. For residential services, if
						the service agreement or amended service agreement identifies a need, such
						services shall be provided within eighteen (18) months of the execution of the
						agreement. The time periods set forth in this section are subject to the funded
						opening and waiting list provisions in sections
						21.01 and
						21.03.
21.04-1
Prior Authorization for
					 Reimbursable Services
Services and units of services must be identified in the
						Person-Centered Service Plan. Requests for all Section
						21 services must be submitted to
						DHHS or its Authorized Entity for Prior Authorization in order for the services
						to be reimbursed.
All Prior Authorizations are time-limited, and the length
						of the authorization may vary by Member and service as documented in the
						Person-Centered Service Plan. Upon expiration of an authorization, a new
						authorization must be obtained before reimbursement may be provided for the
						service.
DHHS and its Authorized Entity reserve the right to
						conduct Utilization Review of any service authorized under this Section,
						applying the service-specific eligibility standards set forth in this Section.
						DHHS and its Authorized Entity may terminate or revise a service authorization
						upon finding that the Member no longer satisfies the eligibility standards for
						the service or level of service authorized.
21.04-2
Person-Centered Service
					 Planning Process
In addition to the Global HCBS Rule provisions concerning
						Person-Centered Planning, the following requirements must be met.
Case Managers shall meet with the Member prior to each
						planning meeting to ensure conflict-free planning and informed choice. The
						planning process must reflect the Member's cultural preferences and provide
						information in plain language that is accessible to the Member and, when
						applicable, his or her legal representative. In addition to the above, and
						according to Title 34-B § 5466, Members are entitled to have access to an
						advocate. Providers must ensure Members are aware of this entitlement prior to
						the planning meeting to allow for inclusion of an advocate if the Member so
						chooses.
21.04-3
Person-Centered Service Plan Requirements
Pursuant to the Global HCBS Rule, the Person-Centered
						Service Plan must reflect the services and supports that are important for the
						Member to meet the needs identified through an assessment of functional need,
						as well as what is important to the Member with regard to preferences for the
						delivery of services and supports. The effective plan date must be less than
						six (6) months old at the time of the Member's eligibility determination or
						redetermination. The planning process must comply with the requirements
						described in the Global HCBS Rule.
The PCSP must include the following:
A. All MaineCare Benefit services determined
					 medically necessary by the team including all other services that may not be
					 covered under this section but the Member identifies and may pursue;
B. The frequency of provision of the services
					 including transportation services;
C. How services contribute to the Member's
					 health and well-being and the Member's ability to reside in a community
					 setting;
D. The Member's goals for
					 strengthening and cultivating personal, community, family, and professional
					 relationships;
E. The role and
					 responsibility of the Member's providers in supporting the Member's goals,
					 including goals for strengthening natural and supportive personal, family,
					 community and professional relationships;
F. Members who choose to receive Home
					 Support-Remote Support must have a safety/risk plan, which shall describe the
					 potential risks to the Member's health and welfare while receiving Home
					 Support-Remote Support and the reasonable steps to alleviate those risks; and
G. In order for the Plan to be
					 authorized, the Plan must include signatures of (1) the Member and guardian, if
					 applicable, (2) the Case Manager and (3) the individuals and providers
					 responsible for the plan's implementation.
The PCSP will be used by DHHS to identify the type and
						units of authorized services the Member may receive under this Section. If more
						than one provider is reimbursed for the same category of direct support
						activities, an explanation of the differences in roles and responsibilities of
						each provider and how services will not be duplicated is required.
All providers must ensure that notice of the grievance
						process outlined in 14-197 CMR ch. 8 (Rule Describing Grievance Process for
						Persons with Intellectual Disabilities and Autism) is regularly provided to
						Members served by the provider. Providing notice includes, at a minimum,
						ensuring that written notice of the grievance process is provided to the Member
						and their guardian at any planning meeting; posting notice of the grievance
						process in an appropriate common area of all facilities operated by the
						provider; and posting notice of the grievance process on any website maintained
						by the provider. In addition, the provider must ensure that all staff are
						trained in the grievance process. Staff must receive training in the grievance
						process upon hire, prior to working with Members and then every thirty-six (36)
						months thereafter.