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-21.14 - APPENDIX I- Shared Living and Family-Centered Per Diem Criteria for increased level of support

Current through 2024-29, July 17, 2024
21.14-1
General
Members who receive services through this Benefit and
						Members applying to receive services through this Benefit may submit a Request
						for Exceptions. The purpose of submitting a Request for Exceptions is to ensure
						that Members receive adequate and appropriate services and supports in the most
						integrated setting appropriate to their needs, consistent with Title II of the
						Americans with Disabilities Act, 42 U.S.C. §§ 12131-12134, and
						consistent with Section
						21 health and safety requirements.
						To achieve that outcome, Members may submit a Request for Exceptions to seek
						services in excess of otherwise-applicable Section
						21 waiver monetary and/or unit
						caps. Members or their Representatives may seek Exceptions by submitting a
						written request.
Filing a Request for Exceptions is neither a waiver of
						nor a substitute for the Member's right to an administrative hearing on an
						appeal under Chapter I, Section 1; to file a grievance under 14-197 C.M.R. ch.
						8; or to file a complaint pursuant to
						34-B M.R.S.
						§5611.
21.14-2
Applications
A. Requests for Exceptions must be submitted
					 in writing on a form provided by the Department by the Member, the Member's
					 Representative, or the Member's Case Manager.
B. For those Members seeking an Exception
					 when applying to receive Section
					 21 services, the Member, the
					 Member's Representative, or the Member's Case Manager shall submit the Request
					 for Exceptions with the materials required under the Section
					 21 regulation for a determination
					 of the Member's medical eligibility for Section
					 21 services. A Member must satisfy
					 all Section
					 21 eligibility requirements,
					 including wait list priorities, if applicable, and obtain a funded offer of
					 Section
					 21 services prior to the
					 Department's consideration of a Request for Exceptions.
C. For those Members who have received a
					 funded offer of Section
					 21 services or are already
					 receiving Section
					 21 Services, Requests for
					 Exceptions shall be submitted to the Department via email to
					 HCBSwaiverexceptions.DHHS@maine.gov, or via US Mail to the Clinical Review Team
					 at the Office of Aging and Disability Services, 11 State House Station, Augusta
					 ME 04333. The Department will acknowledge receipt of a Request for Exceptions
					 from a Section
					 21 Member within five (5) business
					 days.
D. The Member bears the
					 burden of establishing that the Member needs an Exception to:
(i) ensure the Member receives adequate and
					 appropriate services and supports in the most integrated setting appropriate to
					 their needs and to avoid an undue risk of segregation in an institution; and
(ii) that natural supports are not
					 available to meet the needs the Exceptions are intended to address.
E. A Request for Exceptions shall
					 include the following information when known to the Member:
1. The name, address, telephone number, email
					 address, and MaineCare number of the Member and the name, address, telephone
					 number, and email address, of the person who submitted the Request for the
					 Member, if applicable;
2. The
					 specific provision(s) in MBM Chapters II or III, Section
					 21 from which an Exception is
					 requested;
3. The specific
					 Exception(s) requested, the proposed level of service that would result from
					 approval of the Request for Exceptions, and the anticipated duration of the
					 proposed Exception(s);
4. Any
					 relevant facts;
5. A history of the
					 Department's action on the issue including prior communications with the
					 Department on this issue, if applicable;
6. The name, address, and telephone number of
					 any person inside or outside the Department with knowledge of the matter with
					 respect to which the Exception is requested; and
7. Signed releases of information authorizing
					 persons with relevant knowledge or records to furnish the Department with
					 information pertaining to the request, if
					 desired.