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-91.05 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
91.05-1
Member Identification
Members may request CCT or HOME services or be referred
						for CCT or HOME services from any point-of-care at which the Member's needs for
						CCT or HOME services are identified.
CCTs and HOME Providers shall accept referrals and assess
						Members who are potentially eligible for covered services based on the
						eligibility criteria in 91.03 and 91.04. CCTs and HOME Providers shall enroll
						qualifying Members for CCT or HOME services.
91.05-2
Enrollment and Duplication of
					 Services
1.
Enrollment.
CCTs and HOME Providers shall give potentially eligible Members information
					 about the benefits of receiving CCT or HOME services. The Member can choose to
					 be part of a CCT or HOME Provider once confirmed eligible. The Member shall be
					 approved for services effective the earliest date without risk of duplicative
					 services. The Member can choose to not participate at any time by notifying
					 their CCT or HOME Provider or the Department.
2.
Duplication of Services.
The
					 Department will not reimburse for duplicative services for Members. A Member
					 may only receive services from one CCT or HOME
Provider at any given time. If, through the enrollment
						process, the Member is determined to be receiving a duplicative service, the
						Member shall choose which service they want to receive. CCTs and HOME Providers
						shall provide Members with notice that the Members cannot receive duplicative
						services. The Member's choice of services will be retained in the Member's EHR.
						CCT or HOME Provider services do not preclude a Member from receiving other
						medically necessary services.
Members may not receive CCT or HOME services that
						duplicate services from other sections of the
MaineCare Benefits
						Manual
, including the following services:
a. Section
					 13: Targeted Case Management
					 Services
b. Section 17.04-1:
					 Community Integration Services
c.
					 Section 17.04-2: Community Rehabilitation Services
d. Section 17.04-3: Assertive Community
					 Treatment
e. Section
					 46: Psychiatric Hospital Services
					 (except as described 91.08-2)
f.
					 Section
					 67: Nursing Facility Services
					 (except as described 91.08-2)
g.
					 Section
					 92: Behavioral Health Home
					 Services
h. Section
					 93: Opioid Health Home Services
MaineCare services that are covered concurrently with
						HOME services only for a thirty (30) day overlap from the date of admission or
						sixty (60) day overlap prior to the date of discharge to allow for
						comprehensive transitional care include:
i. Section
					 46: Psychiatric Hospital
					 Services
ii. Section
					 67: Nursing Facility
					 Services
3.
Consent Forms:
CCTs and HOME Providers shall retain a signed
					 consent form for all CCT and HOME Provider Members in the Member record. For
					 children receiving services, CCTs and HOME Providers shall retain a signed
					 consent form from a parent or legal guardian. Consent documentation must, at a
					 minimum:
a. Indicate that the Member or parent
					 or legal guardian has received information in writing, and verbally as
					 appropriate, explaining the CCT or HOME Provider purpose and the services
					 provided; and
b. Indicate that the
					 Member or parent or legal guardian has consented in writing, and verbally as
					 appropriate, to receive the CCT or HOME services and understand their right to
					 choose, change, or disenroll from their CCT or HOME Provider at any
					 time.