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-X - DEVELOPMENTAL SERVICES

Current through 2024-29, July 17, 2024
Early intervention diagnostic, therapeutic and referral
					 services may be available through the C.C.S./C.S.H.N. Program for pediatric
					 developmental conditions to include gross and fine motor delays and speech
					 language delays for children from birth up to age eligibility for school entry
					 if the child is referred or in a C.C.S./C.S.H.N. prior authorized therapy
					 program by (March 15) of the year the child is age eligible for school.
A.
Developmental Evaluation
				  Clinics
Coordinated Care Services For Children With Special Health
					 Needs supports community-based Developmental Evaluation Clinics which provide a
					 comprehensive, inter/multi-disciplinary, medically-based, diagnostic assessment
					 to those children under the age of five with suspected developmental problems,
					 who are referred/verified by their primary care provider. The clinics offer,
					 without regard to income, comprehensive evaluations to:
establish developmental baselines;
											 attempt to establish the cause of the identified
						problems through appropriate tests; and
											 develop a comprehensive individualized plan of care
						addressing the child's health issues and developmental problems which
						recommends specific interventions where indicated.
Upon referral, application and determination of income
					 eligibility the C.C.S./C.S.H.N. Program may pre-authorize additional diagnostic
					 studies, laboratory tests and or genetic studies with a Division of Maternal
					 and Child Health grant-funded genetics program only when recommended by a
					 Developmental Evaluation Clinic team and outlined in the evaluation
					 report;
B.
Direct Therapy Intervention Services For Children Ages Birth Up To
				  Age 3
For income eligible children who are ineligible for
					 Medicaid, may lose Medicaid within three (3) months or are not age or otherwise
					 eligible for services through P.L. 101.476, Individuals with Disabilities
					 Education Act and who are referred by their primary care provider, pediatric
					 specialist or subspecialist and/or a Developmental Evaluation Clinic for direct
					 therapeutic services, the C.C.S./C.S.H.N. Program may pre-authorize payment as
					 follows:
1.
Fine and/or
				  Gross Motor Delays
For children ages birth-twelve (12) months with a
						fine and/or gross motor delay of at least three (3) months but not more than
						six (6) months;
												For children ages twelve (12)-twenty-four (24) months
						with a fine and/or gross motor delay of at least six (6) months but not more
						than twelve (12) months;
												For children ages twenty-four (24) - thirty-six (36)
						months demonstrate a fine and/or gross motor delay of at least eight (8) months
						but not more than eighteen (18) months; and/or
												 For children with a neuromuscular disorder which
						interferes with gross and/or fine motor functions:
												occupational/physical therapy consult for a
						diagnostic evaluation with a licensed therapist for up to three (3)
						thirty-minute units. The evaluation must include a comprehensive analysis of
						the child's fine and gross motor skills, oral motor skills where appropriate,
						clearly stated levels of functioning in each area and clearly defined
						recommendations;
												two(2) units or one hour session for the purpose of
						development of a measurable therapy treatment plan. Treatment/care plans shall
						be developed based on information obtained in the diagnostic evaluation and
						shall include the following:
												 long and short term goals and objectives with
						measurable criteria;
												 frequency and length of sessions (in thirty-minute
						units), time period covered, and estimated length of treatment;
												 treatment methods and benchmarks for evaluating
						outcomes;
												 the therapist's plan for including family
						participation in meeting the goals and objectives of reinforcing the
						therapeutic activities;
												 individualized occupational and/or physical therapy
						at a maximum of two (2) thirty minute units per session not to exceed three (3)
						sessions per week for six (6) months, with progress reports and updated
						treatment plans required every six months and before another prior
						authorization is issued.
2.
				  Speech/Language Delay 
				  
												 For those children ages twelve (12)-twenty-four (24)
						with a speech/language delay of at least six (6) months but not more than
						twelve (12) months
												 For those children ages twenty-four (24)-thirty-six
						(36) months with a speech/language delay of at least eight (8) months but not
						more than twelve (12) months:
												 diagnostic evaluation with a licensed speech
						language pathologist for up to three (3) thirty- minute units. The evaluation
						must include a comprehensive analysis of the child's speech/language skills and
						oral motor dysfunction where indicated, clearly stated levels of functioning in
						each area and defined recommendations for intervention;
												 two (2) units one hour session with a licensed
						speech language pathologist for the purpose of development of a therapy plan of
						care. The care plan shall be developed based on information obtained in the
						diagnostic evaluation and shall include the following:
												 long and short term goals and objectives with
						measurable criteria;
												 treatment methods and benchmarks for evaluating
						outcomes;
												 the therapist's plan for including family
						participation in meeting the goals and objectives and in reinforcing the
						therapeutic activities;
												 frequency and length of sessions (in thirty-minute
						units), time period covered, and estimated length of treatment;
												 individualized speech language therapy at a maximum
						of two units/sessions, three (3) sessions per week for up to six (6) months
						with progress reports required at the end of each six month period and before
						another prior authorization is issued.