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-91 - Physician Services › Subsection 144-101-II-91.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
91.01-1
Behavioral and Physical Health
					 Integration
means the care a Member experiences as a result of a team of
					 primary care and behavioral health providers, working together with Members and
					 families, using a systematic and cost-effective approach to provide
					 patient-centered care for a defined population.
91.01-2
Billing Month
is from
					 the 21st of a month to the
					 20th of the following month, e.g. March
					 21st to April
					 20th.
91.01-3
Community Care Team
					 (CCT)
means a multi-disciplinary, community-based and/or
					 practice-integrated care management team that has completed an application and
					 been approved by MaineCare to provide CCT covered services.
91.01-4
Community Health Worker
					 (CHW)
means a trained health worker who applies their unique
					 understanding of the community's experience, socio-economic needs, language
					 and/or culture to advocate for individual and community needs and acts as a
					 bridge between providers and individuals to promote health, reduce disparities,
					 and improve service delivery. CHWs are distinguished from other health
					 professionals in that they are hired primarily for their understanding of the
					 populations and communities they serve, conduct outreach a significant portion
					 of the time, and have experience providing services in community settings.
CHW training shall include CHW core competencies as
						defined by The Community Health Worker Core Consensus Project (see
https://www.c3project.org/roles-competencies
)
						or evidence of a Maine CHW certification or registration, if such a designation
						becomes active in the State of Maine.
91.01-5
Electronic Health Record
					 (EHR)
is a systematic collection of electronic health information about
					 individual patients, including Members. It is a record in digital format that
					 is capable of being shared across different health care settings including via
					 a Department-designated health information exchange(s) (HIE), a
					 Department-designated, network-connected enterprise-wide information system(s),
					 and other information networks or exchanges. An EHR supports clinical EHR
					 functions, such as intake, clinical care, task management, and case management
					 where appropriate, and it has HL7 interoperability capabilities to support the
					 electronic sharing of portions of the patient's record.
91.01-6
Housed
means a Member's
					 status when they have either moved into an apartment, home, or other domicile
					 or in a long-term placement in an assisted living or waiver home
					 setting.
91.01-7
Housing
					 Outreach and Member Engagement Provider (HOME Provider)
is a specialized
					 CCT approved by MaineCare to provide housing outreach and Member engagement
					 services for eligible Members with Long-term Homelessness.
91.01-8
Long-term Homelessness
means residing in a place not meant for human habitation, an emergency shelter,
					 a temporary outdoor shelter, a homeless shelter, or a setting of institutional
					 care or incarceration for a minimum total of 180 days out of either the last
					 365 days or two (2) out of the last three (3) 365-day periods. Stays in a
					 setting of institutional care or incarceration may not account for more than 90
					 of the Member's total homeless days in any one 365-day period. If Long-term
					 Homelessness criteria was met, as defined above, prior to incarceration then
					 the Member is considered to have Long-term Homelessness post
					 incarceration.
91.01-9
Member
means a MaineCare member.
91.01-10
Plan of Care
is a
					 patient-centered plan that describes, coordinates, and integrates all of a
					 Member's clinical information and clinical and non-clinical health care-related
					 needs and services. The Plan of Care shall include Member health care data,
					 Member health goals, and the services and supports necessary to achieve those
					 goals. Services and supports may include, but not be limited to, prevention,
					 wellness, specialty care, behavioral health, transitional care and
					 coordination, and social and community services.