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-20.02 - DEFINITIONS

Current through 2024-29, July 17, 2024
20.02-1
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 M.R.S.
					 §3472.
20.02-2
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 DHHS Medical Eligibility Determination form or
					 other DHHS approved form.
20.02-3
Authorized Entity
is the 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.
20.02-4
BMS 99
is the assessment
					 tool used to determine functional limitations of the member.
20.02-5
Care Coordinator
is a
					 provider organization staff person who is 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.
20.02-6
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.
20.02-7
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.
20.02-8
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 M.R.S.
					 §3472.
20.02-9
Habilitation
is a
					 service that is provided in order to assist a member to acquire a variety of
					 skills, including self-help, socialization and adaptive skills. Habilitation is
					 aimed at raising or retaining the level of physical, mental, and social
					 functioning of a member. Habilitation is contrasted to rehabilitation which
					 involves the restoration of function that a person has lost.
20.02-10
Intellectual Disability
means a diagnosis of Mental Retardation as defined in Section 317-319 in the
Diagnostic and Statistical Manual of Mental Disorders
, Fourth
					 Edition (American Psychiatric Association), that manifested during the
					 developmental period, in accordance with the definition of Intellectual
					 Disability codified in
					 34-B M.R.S.
					 §5001. The terms "mental retardation"
					 and "intellectual disability" are used interchangeably in these
					 regulations.
20.02-11
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.
20.02-12
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.
20.02-13
Money Follows the
					 Person-Homeward Bound Transition Coordinator
is the person who is chosen
					 by the member to provide transition Assistance from the agencies contracted by
					 the Department for the Money Follows the Person-Homeward Bound
					 program.
20.02-14
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.
20.02-15
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 M.R.S.
					 §3472.
20.02-16
Prior Authorization
					 (PA)
is the process of obtaining prior approval as to the medical
					 necessity and eligibility for a service.
20.02-17
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 20 in order for the
					 Authorized Entity to begin utilization review.