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-18 - RULES GOVERNING IMPLEMENTATION OF THE TRADE ADJUSTMENT ASSISTANCE PROGRAM › Subsection 144-101-II-18.02 - DEFINITIONS

Current through 2024-29, July 17, 2024
18. 02-1
Abuse
means the
					 infliction of injury, unreasonable confinement, intimidation or cruel
					 punishment that causes or is likely to cause physical harm or pain or mental
					 anguish; sexual abuse or sexual exploitation; or the intentional, knowing or
					 reckless deprivation of essential needs as defined in 22 MRSA §3472.
18. 02-2
Assessing Services
					 Agency (ASA)
is an Authorized Entity of the Department of Health and
					 Human Services (DHHS) for Medical Eligibility Determinations that conducts
					 face-to-face assessments, using the DHHS Medical Eligibility Determination form
					 or other DHHS approved form.
18.
					 02-3
Authorized Entity
is an organization authorized
					 by the Department of Health and Human Services (DHHS) to perform specified
					 functions pursuant to a signed contract or other approved signed agreement.
18. 02-4
Blocking
is
					 momentary deflection of an individual's movement, when that movement would
					 otherwise be destructive or harmful. Blocking is a moderately intrusive
					 intervention.
18. 02-5
Care
					 Coordinator
is a provider responsible for the development and ongoing
					 support of the implementation of the Care Plan. This includes monitoring of the
					 health, welfare and safety of the participant.
18. 02-6
Care Monitor
is the
					 Department of Health and Human Services (DHHS) professional who assists the
					 member with the member's enrollment in the waiver services and monitors the
					 services received to assure they are meeting the health and safety needs of the
					 member.
18. 02-7
Care
					 Plan
is a comprehensive document that specifies the services a member
					 will receive under this section and the manner in which those services will be
					 provided.
18. 02-8
Contingent Reinforcemen
t is using rewards based upon modification of
					 inherent rights. Positive contingent reinforcement is a reward given contingent
					 upon the occurrence of a target behavior. Negative contingent reinforcement is
					 the removal of an unpleasant event contingent upon the occurrence of a target
					 behavior. Both positive and negative contingent reinforcement result in a
					 higher rate of the target behavior. A contingent reinforcement is a moderately
					 intrusive intervention.
18. 02-9
Environmental alteration
is the modification of a site, activity
					 or schedule that appears to be triggering or contributing to a dangerous or
					 maladaptive behavior.
18. 02-10
Exploitation
means the illegal or improper use of an
					 incapacitated or dependent member or that member's resources for another's
					 profit or advantage as defined in 22 MRSA §3472.
18. 02-11
Extinction
is
					 withdrawal of attention or planned ignoring of the target behavior that is in
					 response to behavior that is disruptive but not harmful or destructive. This is
					 a mildly intrusive behavioral intervention.
18.
					 02-12
Mayo Portland Adaptability Inventory(MPAI)
is
					 a clinical evaluation tool designed to assist in the clinical evaluation of
					 people during the post-acute (post-hospital) period following acquired brain
					 injury (ABI), and to assist in the evaluation of rehabilitation programs
					 designed to serve these people. The MPAI is one of the tools used to establish
					 eligibility and level of care for the waiver initially and on a yearly renewal
					 basis. For more information see this website
http://www. tbims.
					 org/combi/mpai/index. html
18.
					 02-13
Medical Eligibility Determination (MED) Tool
means the form approved by DHHS to assess the medical service needs of the
					 member. The information provided by the MED tool will be used in determining
					 the eligibility for the waiver and authorizing services.
18. 02-14
Member
is a person
					 determined to be eligible for MaineCare benefits by the Office for Family
					 Independence (OFI) in accordance with the eligibility standards published by
					 the OFI in the MaineCare Eligibility Manual. Some members may have restrictions
					 on the type and amount of services they are eligible to receive.
18. 02-15
Natural Supports
include the relatives, friends, neighbors, and community resources that a
					 member or family goes to for support. They may participate in the treatment
					 team, but are not MaineCare reimbursable.
18.
					 02-16
Neglect
means a threat to an member's health
					 or welfare by physical or mental injury or impairment, deprivation of essential
					 needs or lack of protection from these as defined in 22 MRSA §3472.
18. 02-17
Non-exclusionary
					 Timeout
is the voluntary withdrawal of an individual from a reinforcing
					 activity or setting while remaining in the reinforcing environment. Coercion
					 may not be used. This is a mildly intrusive behavioral intervention.
18. 02-18
Overcorrection
is
					 activity done in excess of what would reasonably be required simply to restore
					 a setting or situation to its original state. There are two forms of
					 overcorrection. The first involves activity in excess of what is necessary or
					 desired, such as mopping the entire room when milk is spilled onto the floor,
					 rather than simply cleaning the spill. The second, also called positive
					 practice overcorrection, consists of practicing an alternative more desirable
					 behavior, such as spending ten minutes putting glasses into the dishwasher.
					 This is a moderately intrusive intervention.
18. 02-19
Positive behavioral
					 supports
are supports that help people develop and engage in adaptive,
					 socially desirable behaviors and overcome patterns of destructive and
					 stigmatizing responding, but which do not entail any limitations upon the
					 individual's rights. Positive behavioral support incorporates a comprehensive
					 set of procedures and support strategies that are selectively employed based on
					 an individual's needs, characteristics, and preferences.
18. 02-20
Prior
					 Authorization(PA)
is the process of obtaining prior approval as to the
					 medical necessity and eligibility for a service.
18. 02-21
Redirection
is the
					 distraction or diversion of the attention of an individual from a maladaptive
					 or dangerous behavior to a positive or neutral behavior; a suggestion, by word
					 or gesture, that an individual try an alternate activity. No threats or
					 coercion are involved.
18. 02-22
Target Behavior
is a specific behavior of an individual that is
					 operationally defined. This is the behavior identified in a behavioral
					 intervention with the intention of purposefully increasing or decreasing the
					 rate of the behavior.
18. 02-23
Token
is an object used to positively reward target behavior with
					 the understanding that multiple tokens or objects are exchanged for desired
					 items.
18. 02-24
Token
					 Economy
is a system of positive reinforcement to reward target behavior
					 whereas an individual earns a token for eliciting specific target behaviors. A
					 token Economy is a moderately intrusive intervention.
18. 02-25
Utilization Review
is
					 a formal assessment of the medical necessity, efficiency and appropriateness of
					 services and Care Plans on a prospective, concurrent or retrospective basis.
					 The provider is required to notify DHHS or its Authorized Entity upon
					 initiation of all services provided under Section 18 in order for the
					 Authorized Entity to begin utilization review.
18. 02-26
Verbal reprimand
is a
					 matter-of-fact message, delivered against a background of a generally positive
					 and supportive environment, to express disapproval of an individual's behavior.
					 It must be conveyed without humiliating or threatening language. This is a
					 mildly intrusive behavioral intervention.