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 149-5-69 - OFFICE OF ELDER SERVICES INDEPENDENT SUPPORT SERVICES PROGRAM

Current through 2024-29, July 17, 2024
69.01
DEFINITIONS
(A)
Office of Elder Services
				Independent Support Services Program,
hereinafter referred to as Office
				of Elder Services ISS services is a state funded program to assist individuals
				with household tasks and incidental personal care activities that improve or
				maintain adequate well-being. ISS services may be provided for reasons of
				illness, disability, absence of a caregiver, or to prevent adult abuse or
				neglect. State ISS funds shall be used to purchase only the covered services
				that will foster restoration of independence, consistent with the consumer's
				circumstances and the Authorized Plan of Care. Major service components include
				homemaker services, chore services, home maintenance services, incidental
				assistance with personal hygiene and dressing and household management
				services. State ISS funds may not be used to supplant the resources available
				from families, neighbors, agencies and/or the consumer or from other federal
				and state programs unless specifically provided for in this Section.
(B)
Activities of daily living
				(ADLs)
. ADLs shall only include the following as defined in Section
				69.02(B) (2) for purposes of eligibility: personal hygiene and
				dressing.
(C)
Assessing
				Services Agency (ASA).
Assessing Services Agency means an organization
				authorized through a written contract with Office of Elder Services to conduct
				face-to-face assessments, using the Department's Medical Eligibility
				Determination (MED) form, and the timeframes and definitions contained therein,
				to determine medical eligibility for MaineCare and state-funded covered
				services. Based upon a consumer's assessment outcome scores recorded in the MED
				form, the Assessing Services Agency is responsible for authorizing an initial
				plan of care under Section 69, which shall specify all services to be provided
				under this Section, including the number of hours for services, and the
				provider types. For purposes of this Section, the Assessing Services Agency is
				an Authorized Agent for the Department for medical eligibility determinations
				and plan of care development, and authorization of covered services under this
				Section, including reassessments for consumers served by a Licensed Assisted
				Living Agency.
(D)
Authorized
				Plan of Care
means a plan of care which is authorized by the Assessing
				Services Agency, the ISS Agency or the Department, which shall specify all
				services to be delivered to a consumer under this Section, including the number
				of hours for all covered services. The Authorized Plan of Care shall be based
				upon the outcome of the consumer's assessment, using an assessment form
				approved by the Department. All authorized covered services provided under this
				Section must be listed in a Care Plan Summary.
(E)
Care Plan Summary
is the
				section of the MED form that documents the Authorized Plan of Care 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)
Cognitive capacity to self
				direct:
The consumer must have the cognitive capacity, as measured on
				the MED form, to be able to "self direct" the ISS worker in the self-directed
				option outlined in Section 69.02(B) (3). This capability will be determined by
				the Assessing Services Agency as part of the eligibility determination using
				the MED findings. Minimum MED form scores are (a) decision making skills: a
				score of 0 or 1; (b) making self understood: a score of 0,1, or 2; (c) ability
				to understand others: a score of 0,1, or 2; (d) self-performance in managing
				finances: a score of 0,1, or 2; and (e) support in managing finances, a score
				of 0,1,2, or 3. A consumer not meeting the specific scores will be presumed
				incapable of hiring, firing, training, and supervising the ISS workerunder the
				self-directed plan of care.
(G)
Covered Services are
those services for which payment can be made
				by the Department, under Section 69 of the Office of Elder Services Policy
				Manual.
(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, (10-144 CMR Chapter 332). 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, shower
				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;
(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)
The Independent Support Services
				Agency (ISS Agency)
means an organization, or more than one
				organization, which is authorized, through a written contract with Office of
				Elder Services to conduct a range of activities under this section. For all
				consumers except those receiving ISS services through a Licensed Assisted
				Living Agency, the ISS Agency is the Department's Authorized Agent for the
				following: coordinate and implement the services in the consumer's Authorized
				Plan of Care; ensure that authorized services in the Care Plan Summary are
				delivered according to the service authorizations; conduct required
				re-assessments of ISS consumers; reduce, deny, or terminate services under this
				section; serve as a resource to consumers and their families to identify
				available service delivery options and service providers; answer questions; and
				assist with resolving problems. The ISS Agency is also responsible for
				administrative functions, including: maintaining consumer records; overseeing
				and assuring compliance with policy requirements by its sub-contractors;
				confirming financial eligibility and final determination of the consumer
				co-payment on receipt of the required information; and collecting consumer
				co-payments.
(K)
Household
				members:
means the consumer and spouse.
(L)
Household members' income
includes:
(1) Wages from work, including
				payroll deductions, excluding state and Federal taxes and employer mandated or
				court ordered withholdings;
(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.
(5) 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.
(M)
Instrumental activities of daily
				living (IADLs)
For purposes of the eligibility criteria and covered
				services under this section of policy, IADLs are limited to the following as
				defined by Section 69.02(B)(1): main meal preparation: preparation or receipt
				of the main meal; routine housework; grocery shopping and storage of purchased
				groceries; and laundry either within the residence or at an outside laundry
				facility.
(N)
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.
(O)
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.
(P)
Medical Eligibility Determination
				(MED) Form
shall mean the form approved by the Department for initial
				medical eligibility determinations and service authorization for the plan of
				care based upon the assessment outcome scores. The definitions, scoring
				mechanisms and time frames relating to this form as defined in Section 69
				provide the basis for services and the care plan authorized by the Assessing
				Services Agency. The Care Plan Summary contained in the MED form documents the
				Authorized Plan of Care to be implemented by the ISS Agency or by the Licensed
				Assisted Living Agency. The Care Plan Summary also identifies other services
				the consumer is receiving, in addition to the authorized services provided
				under this Section.
(Q)
One-person Physical Assist
requires one person over the 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.
(R)
Significant Change
A
				significant change is defined as a major change in the consumer's status that
				is not self limiting, impacts on more than one area of their functional or
				health status, and requires multi-disciplinary review or revision of the Plan
				of Care. A significant change assessment is appropriate if there is a
				consistent pattern of changes, with either two or more areas of improvement, or
				two or more areas of decline, that requires a review of the Plan of Care and
				potential for a level of care change.
(S)
Self-Directed Option:
The
				self-directed option means payments made directly to adults to enable them to
				purchase covered ISS services pursuant to Section 69.04.
(T)
Unlicensed Assistive Personnel
means individuals, including personal support specialists and
				homemakers, who, as defined in Title
				22
				MRSA §1717, are employed to provide
				hands-on assistance with activities of daily living to individuals in homes,
				assisted living centers, residential care facilities, hospitals and other
				health care settings. Unlicensed assistive personnel does not include certified
				nursing assistants employed in their capacity as certified nursing
				assistants.
(U)
Licensed
				Assisted Living Agency
meansa provider that is licensed by the
				Department as an Assisted Living Program
and
that holds a valid
				contract with the Office of Elder Services to provide assisted living services.
				The appropriate Licensed Assisted Living Agency is responsible for ensuring
				that services are delivered according to the authorized plan of care;
				maintaining consumer records; confirming financial eligibility and final
				determination of the consumer co-payment on receipt of the required
				information; and collecting consumer co-payments for any ISS consumers residing
				at the facility.