reglab/statecodes huggingface dataset:
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter I - THE MAINE C.C.S./C.S.H.N. PROGRAM › Section 144-272-I-D - Scope of Services

Current through 2024-29, July 17, 2024
The Maine C.C.S/C.S.H.N. Program pays for major
					 subspecialty medical care to include diagnostic, medical, surgical, corrective
					 and therapeutic intervention for children with special health needs ages birth
					 to eighteen when other financial resources are not available. The focus is on
					 continuity and extension of secondary and tertiary care for the children into a
					 community delivery system by paying for subspecialty medical treatment and
					 assuring care coordination, individualized services based on the needs of a
					 particular child and family, and the enabling support structure for the family.
					 Medical eligibility is dependent on diagnosis and the verification that the
					 chronic illness or condition interferes with effective functioning. Program
					 funds are directed toward those low to medium income children with chronic
					 illness, conditions and/or physical handicaps, who are financially ineligible
					 for Medicaid, for whom subspecialty medical or therapeutic treatment
					 intervention can prevent the progression of the disease process and improve the
					 child's functioning where possible.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter I - THE MAINE C.C.S./C.S.H.N. PROGRAM › Section 144-272-I-E - Staffing

Current through 2024-29, July 17, 2024
Coordinated Care Services for Children with Special Health
					 Needs Program is staffed by a director/administrator, assistant director,
					 occupational therapist, children with special health needs coordinator, medical
					 social work consultant, family care coordinator, medical claims adjuster, a
					 medical secretary and two clerical support staff. The C.C.S./C.S.H.N. physician
					 consultant determines a child's medical eligibility for the C.C.S./C.S.H.N.
					 Program and provides ongoing consultation. A nutrition consultant is available
					 for consultation on the nutritional needs of children with special health care
					 needs.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter I - THE MAINE C.C.S./C.S.H.N. PROGRAM › Section 144-272-I-F - Quality Assurance

Current through 2024-29, July 17, 2024
Subspecialty treatment services and care coordination are
					 evaluated by the C.C.S./C.S.H.N. Program through a process of ongoing
					 reassessment. The process allows the family to use their knowledge about their
					 child's condition in the decision-making with the primary care physician and
					 the specialist regarding their child's long term subspecialty treatment by the
					 mutual sharing of information and review of medical care plans. The child's
					 progress is documented in the child's record through both physician reports and
					 parent comments.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter I - THE MAINE C.C.S./C.S.H.N. PROGRAM › Section 144-272-I-G - Limitations of the Program

Current through 2024-29, July 17, 2024
Because of budgetary constraints and limited resources, the
					 Maine C.C.S./C.S.H.N. Program is not a resource for those children whose
					 recommendations include monitoring or observation for purposes of keeping track
					 of a stable or potential health problem or developmental delay, unless
					 otherwise specified. Neither does the C.C.S./C.S.H.N. Program provide coverage
					 for dialysis, end state renal disease, cochlear implants, organ transplants,
					 bone marrow transplants, or any medical therapy that has not been endorsed by
					 the appropriate subspecialty medical board or society. Although it is
					 recognized that advances are continually being made in the treatment of many
					 disorders and conditions, C.C.S./C.S.H.N. does not have the financial and staff
					 resources to manage and provide for subspecialty treatment of all children who
					 could benefit from services.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter III - ELIGIBILITY REQUIREMENTS

Current through 2024-29, July 17, 2024
To be certified as eligible for the Coordinated Care Services
				  for Children with Special Health Needs Program, applicants must meet all of the
				  following requirements.
A. Reside in
				Maine.
B. Be under the age of 18
				unless otherwise specified.
C.
				Diagnostic Eligibility: approval for a consultation or evaluation to establish
				a diagnosis or rule out a suspected disease or condition upon primary care
				referral and receipt of application to the C.C.S./C.S.H.N. Program.
D. Medical Eligibility: verification by the
				physician consultant of the following criterion as outlined in Chapter VI,
				"Conditions and Components of Care":
1.
				restricts physical functioning or causes developmental delays in accordance
				with C.C.S./C.S.H.N. policy;
2.
				requires a level of health care beyond routine and basic care;
3. requires pediatric subspecialty treatment
				and/or developmental therapeutic services for an extended period of
				time;
4. can be maintained or
				improved by such treatment and services; and
5. meets the specific criteria as outlined in
				Chapter VI, "Conditions and Components of Care".
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter IV - C.C.S./C.S.H.N. PROGRAM TERMINATION

Current through 2024-29, July 17, 2024
Program coverage may terminate for any of the reasons listed
				  below:
A. Child is no longer resident
				of Maine;
B. Child reaches the age
				limitation or termination date established for eligibility for service, Chapter
				VI, Section X, p. 40-44;
C. Child
				has achieved maximum alleviation/rehabilitation of the problem or no longer
				requires sub-specialty treatment;
D. Family's income no longer falls within the
				C.C.S./C.S.H.N. income eligibility guidelines;
E. Family fails to provide the required
				annual financial update by the submission deadline;
F. Family voluntarily requests termination of
				service(s) through the program;
G.
				If after a 3 month effort, C.C.S./C.S.H.N. program staff have been unable to
				locate the child/family;
H. There
				exists no documentation or recommendation of a current need for
				service;
I. C.C.S./C.S.H.N. program
				rule change eliminates child's current eligibility or current scope of services
				provided. Anyone made ineligible by future rule changes is notified in writing
				of the proposed rule change and is given the opportunity to comment on the rule
				change through the Maine Administrative Procedures Act process;
J. Child's medical condition no longer meets
				C.C.S./C.S.H.N. Program specific policy as outlined in Chapter VI, Conditions
				and Components of Care and/or Chapter III, Item C;
K. Child no longer qualifies for therapy
				services as outlined in Chapter VI, Section X, p. 41-44; or
a. all long term therapy goals are
				met
b. progress report indicates
				child is maintaining same level of function or less for the past six months
c progress is not possible due to
				the need for further medical/surgical intervention (however, authorization may
				be reinstated after the occurrence of these procedures)
d C.S.H.N. is in receipt of notification from
				the therapist that therapy has terminated
e child reaches age of kindergarten/school
				entry
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter V - C.C.S./C.S.H.N. PROGRAM POLICIES › Section 144-272-V-B - PROCEDURES FOR PAYMENT OF SERVICES

Current through 2024-29, July 17, 2024
1. Payment to
				  prior authorized providers will be made in accordance with the rates
				  established for the Medicaid program within one year of the provision of the
				  prior authorized services. In those instances in which the services authorized
				  are not included in the Medicaid fee schedules, the amount to be paid must be
				  agreed upon by the C.C.S/C.S.H.N. Program prior to authorization.
2. Providers must complete and submit the
				  appropriate state billing form to Medicaid in accordance with the Maine
				  Medicaid billing instructions, within one year of the provision of the prior
				  authorized services. Providers must collect payment from other available
				  insurance prior to billing C.C.S./C.S.H.N. Program and must accept payments
				  made by Coordinated Care Services For Children With Special Health Needs as
				  payment in full.
3. All
				  occupational, physical, and speech/language therapy services must be physician
				  approved and included in the subspecialist's plan of care. Therapy services are
				  prior authorized in units of thirty minute intervals; for services rendered in
				  less than 30 minute intervals, authorized providers will prorate and bill
				  accordingly.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter V - C.C.S./C.S.H.N. PROGRAM POLICIES › Section 144-272-V-C - CONFIDENTIALITY RIGHTS UNDER THE LAW

Current through 2024-29, July 17, 2024
All information as to personal facts and circumstances
					 obtained by C.C.S./C.S.H.N. Program staff with the family's consent constitutes
					 privileged communication, is confidential, and is not to be divulged without
					 the family's consent. Information may, however, be disclosed in summary,
					 statistical, and other forms which does not identify the
					 individuals.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter V - C.C.S./C.S.H.N. PROGRAM POLICIES › Section 144-272-V-D - SECOND OPINION

Current through 2024-29, July 17, 2024
Upon verbal/written request from the family/guardian of a
					 child eligible for services on Coordinated Care Services For Children With
					 Special Health Needs Program or that child's primary or subspecialty provider,
					 C.C.S./C.S.H.N. Program staff will pre-authorize an evaluation with another
					 specialist or therapist to resolve/clarify differences of opinion regarding
					 medical treatment issues and/or issues of interpretation of developmental
					 functioning. C.C.S./C.S.H.N. Program staff may also arrange for the review of
					 the child's records by another subspecialist or therapist from the same
					 discipline when treatment philosophies may differ.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter V - C.C.S./C.S.H.N. PROGRAM POLICIES › Section 144-272-V-E - NON-COVERED SERVICES

Current through 2024-29, July 17, 2024
The Coordinated Care Services for Children with Special
					 Health Needs (C.C.S/C.S.H.N.) Program is not a resource for those children
					 whose diagnostic recommendations include monitoring or observation for purposes
					 of keeping track of a potential or stable health problem or developmental
					 delay, unless otherwise specified.
Because of budgetary constraints and limited resources, the
					 C.C.S./C.S.H.N. Program does not provide coverage for:
routine primary and/or acute care;
										 medical therapy that has not been endorsed by the
						appropriate subspecialty medical society;
										 long term dialysis and related costs;
										 end stage renal disease and related
						costs;
										 any medical treatment not related to the child's
						eligible condition or any primary preventive care, immunizations or acute
						care;
										 any service or treatment not prior authorized as
						outlined in Section A, Authorization of Services and Providers, of this
						chapter;
										 out-of-state treatment as outlined in Section A,
						Authorization of Services and Providers, of this chapter;
										 organ transplants and related costs;
										 bone marrow transplants and related
						costs;
										 amplification devices for neurosensory hearing
						loss;
										 cochlear implants and related costs;
										 augmentative communication equipment;
										 vestibular stimulation equipment such as swings and
						hammocks;
										 orthopedic shoes after first pair of shoes following
						surgery or casting;
										 neonatal intensive care;
										 immunizations;
										 medical treatment and/or medications for allergies;
						or
										 authorizations delegated to other
						providers.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter V - C.C.S./C.S.H.N. PROGRAM POLICIES › Section 144-272-V-F - PARENT/PROVIDER FORUM

Current through 2024-29, July 17, 2024
For those families or providers who verbally or in writing
					 raise concerns or questions regarding denials for payment of discrete bills or
					 services for a C.C.S./C.S.H.N. Program eligible child and do not wish to file a
					 formal appeal, the C.C.S./C.S.H.N. Program Director or his or her designee will
					 review the issue and the child's medical record. The family or provider will be
					 notified in writing of the findings of this review.
If the family or provider is dissatisfied with the decision
					 , the family or provider may request a meeting with the Director of the
					 Division of Maternal and Child Health or his/her designee. This meeting will
					 usually be held at the Department of Human Services, Bureau of Health office in
					 Augusta. However, the family or provider may request a review of the child's
					 written record and payment denial in lieu of a face to face meeting. The
					 decision of the Division Director or his/her designee is final and ends the
					 internal reconsideration process. The family will receive written notification
					 of this decision. The family or provider may appeal any such final decision
					 pursuant to Maine Rule of Civil Procedure Rule 80C and 5 M. R.S.A.11001 et
					 seq.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter V - C.C.S./C.S.H.N. PROGRAM POLICIES › Section 144-272-V-G - PRIORITY FOR PROGRAM EXPENDITURES

Current through 2024-29, July 17, 2024
In the event C.C.S./C.S.H.N. Program administrators
					 anticipate a funding problem, priority for continued service will be directed
					 towards care coordination, subspecialty clinic support and those eligible
					 children in need of surgical or corrective care whose health status would be
					 compromised because of a delay in plan of care
					 implementation.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VI - CONDITIONS AND COMPONENTS OF CARE › Section 144-272-VI-V - GASTROINTESTINAL SYSTEM

Current through 2024-29, July 17, 2024
Prior authorized services through the C.C.S./C.S.H.N.
					 Program are available for congenital anomalies and gastrointestinal disorders
					 as follows:
A.
Congenital
				  Anomalies
For those children who are referred by their primary care
					 providers for subspecialty evaluation and/or treatment for such conditions as
					 but not limited to: atresias of G.I.-tract, diaphragmatic hernia,
					 Hirschsprung's disease, malrotation, omphalocele and tracheoesophageal fistula,
					 the C.C.S./C.S.H.N. Program will pre-authorize payment for:
a diagnostic evaluation/consultation by a pediatric
						gastroenterologist and/or pediatric surgeon. This evaluation may include
						diagnostic studies and related hospitalization costs.
											 surgical components of the plan of care and related
						hospitalization costs upon receipt of the report of the evaluation;
											office visits with the gastroenterologist;
											 consultation with an approved feeding team that
						includes a speech language pathologist, occupational therapist and nutritionist
						if prescribed by the gastroenterologist;
											laboratory tests and imaging studies;
						and/or
											 medications as prescribed by the
						gastroenterologist;
B.
Other Gastrointestinal Problems
For those children who are referred by their primary care
					 providers for subspecialty evaluation and/or treatment for such conditions as
					 but not limited to gastroesphogeal reflux, motility disorders, regional
					 enteritis and/or ulcerative colitis, the C.C.S./C.S.H.N. Program will
					 pre-authorize payment for:
a diagnostic evaluation/consultation by a pediatric
						gastroenterologist;
											surgical components of the plan of care and related
						hospitalization upon receipt of report of the evaluation;
											office visits with the gastroenterologist;
											laboratory tests and medications as prescribed by the
						gastroenterologist; and/or
5. medical
				  nutrition therapy consultation as recommended by the
				  gastroenterologist.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VI - CONDITIONS AND COMPONENTS OF CARE › Section 144-272-VI-VI - GENITOURINARY SYSTEM

Current through 2024-29, July 17, 2024
Prior authorized services through the C.C.S./C.S.H.N.
					 Program are available for congenital anomalies of the genitourinary tract and
					 other chronic genitourinary conditions to include but not limited to anomalies
					 of vagina, chronic glomerulonephritis, extrophy of bladder and hypospadias as
					 follows:
For those children who are referred by their primary care
					 providers for subspecialty evaluation and/or treatment, the C.C.S./C.S.H.N.
					 Program will pre-authorize payment for:
diagnostic evaluation/consultation by a pediatric
						urologist or nephrologist. This evaluation may include laboratory tests and
						related hospitalization costs;
										surgical components of the plan of care and related
						hospitalization costs upon receipt of the report of the evaluation;
										 office visits with the pediatric urologist or
						nephrologist and related tests; and/or
										 medications that require a written prescription for
						urinary tract infections as prescribed by the treating
						subspecialist.
NON-COVERED GENITOURINARY SERVICES
: dialysis
					 and renal transplants.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VI - CONDITIONS AND COMPONENTS OF CARE › Section 144-272-VI-VIII - SKIN SYSTEM

Current through 2024-29, July 17, 2024
Prior authorized services are available through the
					 C.C.S./C.S.H.N. Program for congenital and or chronic conditions of the skin
					 such as destructive hemangioma and lymphangioma and for congenital lesions of
					 the skin that may be cancerous as follows:
For those children who are referred by their primary care
					 providers for subspecialty evaluation and/or treatment, the C.C.S./C.S.H.N.
					 Program will pre-authorize payment for:
diagnostic evaluation by a dermatologist;
										 surgical components of the plan of care, laser
						treatment and related hospitalization costs upon receipt of the report of the
						evaluation;
										 office visits with the dermatologist;
						and/or
										 laboratory tests and medications as prescribed by
						the treating dermatologist;
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VI - CONDITIONS AND COMPONENTS OF CARE › Section 144-272-VI-IX - CHILDHOOD ONCOLOGY

Current through 2024-29, July 17, 2024
Prior authorized services are available through the
					 C.C.S./C.S.H.N. Program for pediatric malignancies and their complications as
					 follows:
For those children who are referred by their primary care
					 provider, the Maine Children's Cancer Program or other approved pediatric
					 cancer treatment program for subspecialty diagnostic and treatment services,
					 the C.C.S./C.S.H.N. Program will pre-authorize payment for:
diagnostic evaluation by a pediatric hematologist or
						oncologist. This evaluation may include laboratory tests, x-rays and other
						imaging studies and related hospitalization costs;
										 surgical components of the plan of care to include
						related hospitalization costs upon receipt of the report of the
						evaluation;
										 office visits and hematology/oncology inpatient and
						outpatient services during active cancer treatment or complications of
						treatment including as outlined in the child's plan of care;
										chemotherapy and radiation therapy;
										medication prescribed by the treating subspecialist
						including prescription pain medication;
										 prostheses and orthoses;
										 rehabilitative services to include physical,
						occupational and speech/language therapy for up to six (6) months following
						surgery or if required as a result of the complications of
						chemotherapy;
										 community-based nursing services as requested in the
						hematologist's/oncologist's plan of care;
										 medical nutrition therapy with a registered
						dietitian;
										 routine and restorative dental care up to
						$150.00/year at state rates of reimbursement during active cancer treatment;
						and/or
										 office visits with the pediatric hematologist or
						oncologist and related tests for up to three (3) years following the completion
						of the child's treatment.
NON-COVERED SERVICE:
bone marrow
					 transplants
.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-A - Adaptive Equipment

Current through 2024-29, July 17, 2024
For children receiving SSI disability benefits who would
					 otherwise be ineligible for the C.C.S./C.S.H.N. Program and for children up to
					 school age eligibility who have a medically eligible condition the
					 C.C.S./C.S.H.N. Program will pre-authorize payment for:
adaptive equipment or adaptation of equipment such
						as but not limited to, therapy balls and bolsters which are not covered by
						Medicaid or other payment source, upon written request/or documentation of the
						child's medical condition and need for adaptive equipment from the treating
						subspecialty physician and therapist; and/or
										 adaptive equipment with orthopedic and developmental
						implications (i.e., prone or supine standers and sidelyers) as prescribed by
						the child's treating orthopedist or physiatrist.
NON-COVERED EQUIPMENT:
vestibular stimulation
					 equipment and augmentative communication equipment.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-B - Diagnostic Services

Current through 2024-29, July 17, 2024
Selected subspecialty diagnostic evaluations and/or
					 consultations are available through the C.C.S./C.S.H.N. Program for income
					 eligible children upon request, referral, or documentation of a suspected
					 chronic or acquired chronic illness or physically handicapping condition from
					 the child's primary care provider or treating subspecialist as follows:
diagnostic evaluation with the appropriate
						subspecialist or pediatric specialist to confirm or rule out a congenital
						disorder, chromosomal abnormality, cardiac disease, neurological disorder or
						physically handicapping condition; and/or
										 referral to a Developmental Evaluation Clinic for
						children under the age of five with or at risk of developmental delays unless a
						similar comprehensive evaluation has already taken place.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-C - Dietary Supplements

Current through 2024-29, July 17, 2024
For those children whose treating subspecialist prescribes
					 dietary supplements that require nutrients not obtainable from food, the
					 C.C.S./C.S.H.N. Program will pre-authorize payment for formula or special
					 medical food only when the nutritional composition of the formula/food
					 represents an integral part of the treatment for the child's eligible condition
					 as outlined under the specific conditions in Chapter VI, and the child is seen
					 by a registered dietitian at least every four months.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-D - Durable Medical Equipment

Current through 2024-29, July 17, 2024
For those children requiring durable medical equipment the
					 C.C.S./C.S.H.N. Program will pre-authorize payment for the following equipment
					 if prescribed by the prior authorized subspecialist and included in the child's
					 plan of care:
braces, splints, wheelchairs and appropriate
						attachments, special walkers, crutches and artificial limbs in compliance with
						Medicaid guidelines as outlined in Chapter VI: Section I, I tem D 13; p.
						26;
										 first pair only of corrective orthopedic shoes
						following serial casting or surgical correction if prescribed by the pediatric
						orthopedist;
										 prosthetic eyes and replacements as outlined in
						these rules, Chapter VI; Section I, I tem E, p. 26; and/or
										prosthetic amplification devices only when
						pre-authorized in conjunction with reconstructive surgery of the auditory canal
						and/or ossicular chain and included in the treating subspecialist plan of
						care.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-E - Genetic Counseling

Current through 2024-29, July 17, 2024
For income eligible children who are referred by their or
					 their treating subspecialist, a Developmental Evaluation Clinic or other MCH
					 supported specialty clinic for a genetic consultation, the C.C.S./C.S.H.N.
					 Program will refer to a Maternal and Child Health grant-funded genetic center
					 for evaluation and/or genetic counseling and will pre-authorize those genetic
					 studies required over and above the basic consultation fee.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-F - Medical Nutrition Therapy

Current through 2024-29, July 17, 2024
For children referred by their subspecialist for a
					 nutritional consultation and or counseling because they may be at nutritional
					 risk as a result of their medically eligible disease or condition, the
					 C.C.S./C.S.H.N. Program will pre-authorize payment for:
nutritional evaluation/consultation with a
						registered dietitian when included in the subspecialist's plan of
						care;
										 nutritional counseling for up to two units per week
						(one hour) with a registered dietitian upon receipt of the dietitians plan of
						care and when the nutritional risk is directly related to the child's medically
						eligible condition.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-G - Neonatal Services

Current through 2024-29, July 17, 2024
For income eligible neonates birth up to thirty (30) days
					 of age the following supplemental services are available retroactive to the
					 date of birth if the application and medical center referral and verification
					 is received within the first month of birth:
initial emergency transport to an in-state Level II
						or Level III facility as classified by the Maine State Health Department and
						return to a lower level in-state facility as medically indicated; transport to
						an out-of state tertiary care center is available only on referral by Eastern
						Maine Medical Center, Central Maine Medical Center, or Maine Medical
						Center;
										 pediatric subspecialty diagnostic evaluations and
						consultations at an in-state Level II or Level III facility; and/or
										 surgeon costs only for emergency surgery.
NON-COVERED NEONATAL SERVICES:
Routine care of
					 the newborn, or neonatal intensive care.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-H - Occupational and/or Physical Therapy Consultation

Current through 2024-29, July 17, 2024
For those children who upon request and referral from the
					 treating subspecialist, may require occupational and /or physical therapy
					 consultation outside of the services outlined in Chapter VI, Section X, p.
					 40-44, the C.C.S./C.S.H.N. Program will pre-authorize payment for occupational
					 or physical therapy re-evaluation/consultation to provide the child's
					 caregiver, educator, school therapist or other adult caring for the child
					 technical assistance to implement the plan of care/therapeutic exercises
					 initially recommended by the treating subspecialist. Consultation will be
					 provided up to three (3) units per session or one and one-half (1 1/2 hours)
					 for a frequency of up to one time per month.
NON-COVERED THERAPY SERVICES:
collateral
					 contacts; travel reimbursement for the child and/or his or her family; travel
					 reimbursement for the prior authorized provider.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-I - Orthodontia

Current through 2024-29, July 17, 2024
For those children only who are medically and financially
					 eligible on the basis of cleft lip and palate or another congenital
					 cranio-facial anomaly with similar treatment complexities, the C.C.S./C.S.H.N.
					 Program will pre-authorize Orthodontic care upon recommendation of the Cleft
					 Palate Clinic team (Chapter VI, Section II, I tem A, p. 29) and when the need
					 is due to the eligible condition.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-J - Pharmaceutical Services

Current through 2024-29, July 17, 2024
For those children requiring medications to treat their
					 medically eligible condition and prescribed by the treating subspecialist or
					 pediatric specialist, the C.C.S./C.S.H.N. Program will pre-authorize payment
					 for:
medications requiring a written prescription unless
						otherwise stated; and/or
										long term medications requiring a written
						prescription that are included in the subspecialist's plan of care whose
						refills can be renewed and monitored by the child's primary care physician. Any
						change in prescription requires the verification of the treating
						subspecialist.
NOTE:All pharmaceuticals require prior authorization,
					 whether verbally or in writing.
NON-COVERED PHARMACEUTICAL SERVICES:
over-the-counter medications unless otherwise stated, and "less than effective
					 drugs" as defined by the Food and Drug Administration and on file with the
					 Bureau of Medical Services, the State Medicaid program.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-K - Psycho-social Counseling

Current through 2024-29, July 17, 2024
For medically eligible children and their families who
					 experience problems in their psycho-social functioning due to the child's
					 medically eligible condition and who refer themselves in writing or by phone,
					 and if the family's request is followed by a recommendation for this service by
					 the child's treating subspecialist, the C.C.S./C.S.H.N. Program will
					 pre-authorize payment for:
1. initial
				  psycho-social evaluation for up to two (2) one-hour sessions with a licensed
				  counselor/psychologist. Families may choose their own Medicaid enrolled
				  provider who must be from one of the following categories:
a. licensed clinical psychologists;
b. licensed psychiatrists;
c. licensed masters social workers;
d. licensed clinical social
				  workers;
e. licensed psychiatric
				  nurses.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VII - SUPPLEMENTAL SERVICES THROUGH THE C.C.S./C.S.H.N. PROGRAM › Section 144-272-VII-L - Respiratory Therapy

Current through 2024-29, July 17, 2024
For children with cystic fibrosis or broncho pulmonary
					 dysplasia the C.C.S./C.S.H.N. Program will pre-authorize respiratory therapy
					 upon recommendation from the clinic team at a location as close to the child's
					 home as possible.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-A - PURPOSE

Current through 2024-29, July 17, 2024
To guarantee each applicant and recipient the right to an
					 administrative hearing to appeal a decision of ineligibility or C.C.S./C.S.H.N.
					 Program termination that adversely affects an individual's ability to benefit
					 from the C.C.S./C.S.H.N. Program. The administrative hearing process is
					 designed to secure and protect the interests of the client and the State Agency
					 and to insure equitable treatment of all involved. The purpose of the hearing
					 is to determine if C.C.S./C.S.H.N. Program staff's decision of ineligibility
					 and termination are in compliance with approved C.C.S./C.S.H.N. Program
					 regulations, the State Agency will follow the procedure set forth in the
					 following administrative hearing procedure.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-B - DEFINITIONS

Current through 2024-29, July 17, 2024
Unless otherwise indicated, the following terms shall have
					 the following meanings:
1. Appellant:
				  an applicant or recipient who is determined to be ineligible for the Program
				  and who appeals that determination.
2. Hearings Officer: an impartial person
				  within the Department of Human Services designated to conduct hearings and to
				  render decisions pursuant to the regulations governing the C.C.S./C.S.H.N.
				  Program. The Officer is deemed impartial if the Officer did not participate in
				  rendering the decision under appeal, or if the Officer did not confer with
				  C.C.S./C.S.H.N. Program staff prior to the administrative hearing about the
				  appeal.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-C - NOTIFICATION OF APPEAL RIGHTS

Current through 2024-29, July 17, 2024
1. Ineligible at
				  time of application: An applicant found ineligible for the C.C.S./C.S.H.N.
				  Program at the time of application or after the receipt of appropriate medical
				  information, shall receive written notice of the C.C.S./C.S.H.N. Program's
				  determination at the time the action is taken. This notice will contain the
				  following information at a minimum:
a. the
				  determination;
b. the basis for
				  ineligibility and a citation to the statute or regulation that supports that
				  decision;
c. the statement that the
				  applicant has a right to appeal that decision; and
d. an explanation of the procedure to obtain
				  a hearing.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-D - INFORMAL CONFERENCE

Current through 2024-29, July 17, 2024
If an applicant or recipient (or said applicants' or
					 recipients' parents or guardian where appropriate) is aggrieved by a decision
					 to the C.C.S./C.S.H.N. Program and seeks to appeal that decision, the applicant
					 or recipient must request an informal conference in writing, within fifteen
					 (15) days from the date of the letter. The appellant must submit the request to
					 the C.C.S./C.S.H.N. Program Director and state with specificity the basis for
					 the appeal. The appellant waives all appeal rights on any issue not raised in
					 the initial request for informal conference. The informal conference shall be
					 scheduled as soon as practicable, but in no case later than forty-five (45)
					 days from the C.C.S./C.S.H.N. Program's receipt of the request for informal
					 conference. At the informal conference, the appellant may be represented by
					 legal counsel, relative, friend, or other spokesperson. The appellant or his or
					 her representative may ask any questions or present any new clarifying
					 information in support of the appellant's position concerning the basis of the
					 appeal. Whatever issues are not raised at the informal conference are waived.
					 The C.C.S./C.S.H.N. Program Director shall issue a written decision with
					 findings of the informal conference. If the appellant is dissatisfied with the
					 results of the informal conference, he or she may request an administrative
					 hearing.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-E - PROCEDURE TO REQUEST AN ADMINISTRATIVE HEARING

Current through 2024-29, July 17, 2024
An appellant who is aggrieved by the informal conference
					 decision may request an administrative hearing. Appellants must follow the
					 procedures described below to obtain a hearing:
1. The appellant must request an
				  administrative hearing within (30) thirty days from the date the
				  C.C.S./C.S.H.N. Program mails the informal conference decision. The appellant
				  may request a earing orally, or in writing. The C.C.S./C.S.H.N. Program
				  Director or designee shall reduce an oral request to writing.
2. The appellant must submit the hearing to
				  the Program Director, Coordinated Care Services for Children with Special
				  Health Needs, Bureau of Health, Station 11, Augusta, Maine 04333. For purposes
				  of the hearing, the date of request is the date the written request is received
				  by the C.C.S./C.S.H.N. Program Director, or the oral request is received by the
				  C.C.S./C.S.H.N. Program Director. The C.C.S./C.S.H.N. Program Director may
				  request the appellant to submit a written hearing request, but the date of
				  request shall remain the date on which the oral hearing request was
				  made.
3. Upon receipt of a hearing
				  request, the C.C.S./C.S.H.N. Program Director shall prepare an Administrative
				  Hearing Report Form (as required by Section VII(B) (4) of the Administrative
				  Hearings Manual) and transmit it to the Office of Administrative
				  Hearings.
4. The administrative
				  hearing will be conducted in conformity with 5 M.R.S.A. Section8001 et seq.
				  (the "Maine Administrative Procedure Act") and the regulations of the
				  Department's Office of Administrative Hearings (the "Administrative Hearings
				  Manual").
5. An impartial hearings
				  officer shall conduct the administrative hearing.
6. The Department of Human Services is bound
				  by the hearings officer's or Commissioner's decision. However, the appellant
				  who disagrees with the hearings officer's or Commissioner's decision has the
				  right to judicial review pursuant to Rule 80C of the Maine Rules of Civil
				  Procedures.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-F - DENIAL OR DISMISSAL OF A FORMAL ADMINISTRATIVE HEARING REQUEST

Current through 2024-29, July 17, 2024
The Department may dispute a right to a hearing as set
					 forth in Section VI(B) (4) of the Administrative Hearings
					 Manual.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-G - CONTINUATION OF BENEFITS

Current through 2024-29, July 17, 2024
C. C. S./C.S.H.N. Program recipients who appeal timely the
					 termination, discontinuance, suspension, or reduction of services within
					 fifteen (15) days of the C.C.S./C.S.H.N. Program's date of notification of
					 ineligibility for further participation by request for an informal conference
					 shall continue to receive C.C.S./C.S.H.N. Program coverage until the date of
					 Hearing Decision by the Hearings Officer. Applicants who are denied service at
					 the initial determination may appeal the denial but shall not receive program
					 service while awaiting the hearing.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 272 - COORDINATED CARE SERVICES FOR CHILDREN WITH SPECIAL HEALTH NEEDS › Chapter VIII - ADMINISTRATIVE HEARING POLICY › Section 144-272-VIII-H - THE ADMINISTRATIVE DECISION

Current through 2024-29, July 17, 2024
The decision of the administrative hearings officer shall
					 be binding on the C.C.S./C.S.H.N. Program.
If the decision is in favor of the appellant and services
					 were denied or discontinued, coverage shall begin within sixty (60) days. If
					 the decision is not in the appellant's favor, as soon as administratively
					 feasible, any continued coverage shall be terminated.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 274 - IMMUNIZATION INFORMATION SYSTEM (IIS) RULES › Section 144-274-1 - Intent

Current through 2024-29, July 17, 2024
The Immunization Information System is intended to be a
				  repository for accurate and up to date immunization records for all persons
				  born, residing, or receiving vaccine in the State of Maine. The primary purpose
				  of the system is to collect data related to vaccine administration, and to
				  promote effective and cost efficient prevention of vaccine preventable
				  diseases. This rule is issued pursuant to the statutory authority of the
				  Department of Human Services under
				   22 M.R.S.A.
				  §1064. Administration of the system
				  shall be performed by the Department's Immunization Program.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 274 - IMMUNIZATION INFORMATION SYSTEM (IIS) RULES › Section 144-274-2 - Scope

Current through 2024-29, July 17, 2024
These Rules apply to all Immunization Providers and other
				  entities who have a contract or Memorandum of Agreement with the Department to
				  participate in the vaccine distribution system, the Immunization Information
				  System or to provide related support services.