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-17 - Community Support Services › Subsection 144-101-II-17.02 - ELIGIBILITY FOR CARE

Current through 2024-29, July 17, 2024
17.02-1
Requirements for Eligibility
. A person is eligible to receive
					 covered services if he or she meets both general MaineCare eligibility
					 requirements and specific eligibility requirements for Community Support
					 Services. Eligibility for services under the
MaineCare Benefits
					 Manual
, Chapter II, Section
					 13, Targeted Case Management
					 Services, Section
					 65, Behavioral Health Services,
					 Section
					 91, Health Home Services and
					 Section
					 92, Behavioral Health Home
					 Services may not preclude eligibility for covered services under this Section.
					 However, services must be coordinated and not duplicated.
17.02-2
General Requirements
.
					 Individuals must meet the eligibility criteria as set forth in the
MaineCare Eligibility Manual
. Some members may have
					 restrictions on the type and amount of services they are eligible to
					 receive.
17.02-3
Specific
					 Requirements
. A member meets the specific eligibility requirements for
					 covered services under this section if:
A.
					 The person is age eighteen (18) or older or is an emancipated minor and meets
					 criteria for a Serious and Persistent Mental Illness as follows:
1. A primary diagnosis of Schizophrenia or
					 Schizo affective disorder in accordance with the
Diagnostic and
					 Statistical Manual
, 5th edition (DSM 5)
					 criteria; or
2. Another primary DSM
					 5 diagnosis or DSM 4 equivalent diagnosis with the exception of Neurocognitive
					 Disorders, Neurodevelopmental Disorders, Antisocial Personality Disorder and
					 Substance Use Disorders who:
a) has a written
					 opinion from a clinician, based on documented or reported history, stating that
					 he/she is likely to have future episodes, related to mental illness, with a
					 non-excluded DSM 5 diagnosis, that would result in or have significant risk
					 factors of homelessness, criminal justice involvement or require a mental
					 health inpatient treatment greater than seventy-two (72) hours, or residential
					 treatment unless community support program services are provided; based on
					 documented or reportedhistory; for the purposes of this section, reported
					 history shall mean an oral or written history obtained from the member, a
					 provider, or a caregiver; or
b) has
					 received treatment in a state psychiatric hospital, within the past twenty-four
					 (24) months, for a non-excluded DSM 5 diagnosis; or
c) has been discharged from a mental health
					 residential facility, within the past twenty-four (24) months, for a
					 non-excluded DSM 5 diagnosis; or
d)
					 has had two or more episodes of inpatient treatment for mental illness, for
					 greater than seventy-two (72) hours per episode, within the past twenty-four
					 (24) months, for a non-excluded DSM 5 diagnosis; or
e) has been committed by a civil court for
					 psychiatric treatment as an adult; or
f) until the age of twenty-one (21), the
					 recipient was eligible as a child with severe emotional disturbance, and the
					 recipient has a written opinion from a clinician, in the last twelve (12)
					 months, stating that the recipient had risk factors for mental health inpatient
					 treatment or residential treatment, unless ongoing case management or community
					 support services are provided.
AND