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-20.03 - DETERMINATION OF ELIGIBILITY

Current through 2024-29, July 17, 2024
20.03-1
Approved Opening
The number of MaineCare members who can receive services
						under this section is limited to the number of openings approved by the Centers
						for Medicare and Medicaid Services (CMS). Persons who would otherwise be
						eligible for services under this section are not eligible to receive services
						if all of the approved openings are filled.
20.03-2
General Eligibility
					 Criteria
Consistent with Subsection 20.03-1, a person is eligible
						for services under this section if the person:
A. Is age twenty one (21) or older;
					 and
B. Has a Related Condition
					 within the meaning of
					 42 C.F.R. §
													435.1010.
A "Related Condition" must meet all of the following
						conditions:
1. It is attributable to;
a. Cerebral Palsy or Epilepsy; or
b. Any other condition, other than mental
					 illness, found to be closely related to Intellectual Disabilities because this
					 condition results in impairment of general intellectual functioning or adaptive
					 behavior similar to that of persons with Intellectual Disabilities and requires
					 treatment or services similar to those required for these persons. These
					 conditions include but are not limited to Neurofibromatosis, Other Choreas,
					 Anoxic Brain Damage, Cerebral Laceration and Contusion, Subarachnoid- Subdural
					 and Extradural Hemorrhage following injury, Other and Unspecified Intracranial
					 Hemorrhage following injury or Intracranial injury and unspecified nature,
					 Muscular Dystrophy, Huntington's, Spina Bifida or other rare developmentally-
					 based conditions.
2. It
					 is manifested before the person reaches age twenty two (22).
3. It is likely to continue
					 indefinitely.
4. It results in
					 substantial functional limitation in three (3) or more of the following areas
					 of major life activity:
a.
					 Self-care.
b. Understanding and use
					 of language.
c. Learning.
d. Mobility.
e. Self-direction.
f. Capacity for independent living;
					 and
C. Meets
					 the medical eligibility criteria for admission to an Intermediate Care Facility
					 for Individuals with Intellectual Disabilities (ICF/IID) as set forth under the
MaineCare Benefits Manual
, Chapter II, Section 50;
					 and
D. Does not receive services
					 under any other federally approved MaineCare home and community based waiver
					 program; and
E. Meets all MaineCare
					 eligibility requirements as set forth in the
MaineCare Eligibility
					 Manual
; and
F. The
					 estimated annual cost of the member's services under the waiver is equal to or
					 less than one hundred percent (100%) of the state-wide average annual cost of
					 care for a member in an Intermediate Care Facility for Individuals with
					 Intellectual Disabilities (ICF/IID), as determined by DHHS; and
G. Can have his or her health and welfare
					 needs assured in the community setting as stated in § 20.08-2(E) (1) and
					 (2).