Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 197 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 11 - CONSUMER-DIRECTED PERSONAL ASSISTANCE SERVICES › Section 197-11-06 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
(A)
Eligibility Determination
An eligibility assessment, using the Department's approved
				  Medical Eligibility Determination (MED) form, shall be conducted by the
				  Department or the ASA. All Home Based Care services require an eligibility
				  determination and prior authorization by the Authorized Agent to determine
				  eligibility pursuant to Section 11.02.
(1) The ASA will accept verbal or written
				referral information on each prospective new consumer, to determine
				appropriateness for an assessment. When funds are available to conduct
				assessments, prospective consumer's will receive a face to face medical
				eligibility determination assessment at their current residence within fifteen
				(15) business days of the date of referral to the Authorized Agent. All
				requests for assessments shall be documented indicating the date and time the
				assessment was requested and all required information provided to complete the
				request. The individual conducting the assessment shall be a Registered Nurse
				(RN), occupational therapist (OT) or a certified occupational therapy assistant
				(COTA), whose work will be reviewed and signed off by an OT, and will be
				trained in conducting assessments and developing an authorized plan of service
				with the Department's approved MED tool. The assessor's findings and scores
				recorded in the MED form shall be the basis in establishing eligibility for
				services and the authorized plan of service. The anticipated costs of covered
				services to be provided under the authorized plan of service must conform to
				the limits set forth in Section 11.03(A).
(2) The ASA shall inform the consumer of
				available community resources and authorize a plan of service that reflects the
				identified needs documented by scores and timeframes on the MED form, giving
				consideration to the consumer's living arrangement, informal supports, and
				services provided by other public and private funding sources. CDHBC services
				provided to two or more consumer's sharing living arrangements shall be
				authorized by the Authorized Agent with consideration to the economies of scale
				provided by the group living situation, according to limits in Section 11.03.T
				he Authorized Agent shall authorize a plan of service based upon the scores and
				findings recorded in the MED assessment. The covered services to be provided in
				accordance with the authorized plan of service shall: 1) not exceed the lesser
				of the monthly plan of service authorized by the Authorized Agent or the
				Maximum Authorized Service established by Department of Health and Human
				Services; and 2) be prior authorized by the Department or its Authorized Agent.
				The assessor shall approve an eligibility period for the consumer, based upon
				the scores and needs identified in the MED assessment and the assessor's
				clinical judgment.
(3) The
				assessor will provide a copy of the authorized service plan, in a format
				understandable by the average reader and approved by the Department, a copy of
				the eligibility notice, release of information and the appeal hearing rights
				notice, to the consumer at the completion of the assessment. The assessor will
				inform the consumer of the estimated co-payment and the cost of services
				authorized.
(4) The assessor shall
				forward the fully completed assessment packet to the Department within five (5)
				business days of the medical eligibility determination and authorization of the
				plan of service. The Department will not approve eligibility or payment without
				a fully completed assessment.
(5)
				The Authorized Agent will complete initial skills training within thirty (30)
				days of the date of the completion of the medical eligibility determination
				form. Payment of Consumer Directed services can begin only after the Department
				is notified that the consumer has successfully completed this training and the
				complete medical eligibility packet has been received.