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 197-11-03 - DURATION OF SERVICES

Current through 2024-29, July 17, 2024
Each Consumer Directed Home Based Care consumer may receive
				  as many covered services as identified, documented and authorized on the MED
				  form, as required, within the limitations and exceptions described below. Home
				  Based Care coverage of services under this Section requires prior authorization
				  from the Department or its Authorized Agent. Beginning and end dates of an
				  individual's medical eligibility determination period correspond to the
				  beginning and end dates for Home Based Care coverage of the plan of service
				  authorized by the Authorized Agent or the Department. The services provided
				  must be reflected in the Service Plan and based upon the authorized covered
				  services documented in the care plan summary of the MED form. The Maximum
				  Authorized Service amount is 40 hours of services per week.
(A)The total monthly cost of services may not
				exceed the lesser of the monthly plan of service authorized by the Authorized
				Agent or the monthly cap, established by the Department.
(B) Suspension. Services will be suspended if
				the consumer is hospitalized or using institutional care. If such circumstances
				extend beyond thirty (30) days the consumer must be reassessed to determine
				appropriate services. Upon discharge from a hospital or institutional care
				facility, the consumer's previous level of service will resume until a
				reassessment is conducted. The reassessment will be conducted within two weeks
				following the consumer's discharge from the hospital or institutional care
				facility.
(C) Services under this
				Section may be suspended, reduced, denied or terminated by the Department or
				the Authorized Agent, as appropriate depending on the nature and severity of
				the situation, for the following reasons:
(1)
				The consumer does not meet eligibility requirements;
(2) The consumer declines services;
(3) The consumer is eligible to receive
				services under a MaineCare program, including any MaineCare Home or Community
				Based waiver program or a State funded long term care services
				program;
(4) Based on the
				consumer's most recent MED assessment, the plan of service is reduced to match
				the consumer's needs as identified in the reassessment and subject to the
				limitations of the program cap;
(5)
				The health or safety of the consumer or of individuals providing services is
				endangered;
(6) Consumer refuses
				personal assistance services;
(7)
				Consumer has failed to make his/her calculated monthly co-payment within thirty
				(30) days of receipt of the co-pay bill;
(8) When the consumer gives fraudulent
				information, including, but not limited to assessment information and
				reporting, payroll records, and all other recordkeeping documents to
				theDepartment of Health and Human Services or the Authorized Agent;
(9) The consumer fails to personally manage
				an assistant;
(10) The consumer is
				using program funds to pay the Personal Assistant to complete tasks outside the
				covered services described in Section 11.04;
(11) Failure of a consumer to demonstrate the
				skills necessary to successfully manage his/her personal-health maintenance,
				including management of the PA in compliance with these rules;
(14) The consumer endorses or attempts to
				endorse a check that is made payable to the PA;
(15) The consumer fails to carryout his/her
				responsibilities for FICA withholding, unemployment insurance or worker's
				compensation insurance;
(16) In the
				event that a consumer is found to have used program funds in violation of the
				requirements of this section, the consumer must reimburse the Authorized Agent
				for all such funds before being subsequently considered for services under this
				Chapter.
(17) In the event that
				services have been denied or terminated by the Authorized Agent or the
				Department for any of the reasons included in this section, such actions will
				be afactor in determining eligibility in any subsequent application for
				services under this rule.
Notice of intent to reduce, deny, or terminate services under
				  this section will be done in accordance with Section 11.13 of this
				  rule.