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-20 - Home and Community Based Services for Adults with Other Related Conditions › Subsection 144-101-II-20.04 - CARE PLAN DEVELOPMENT

Current through 2024-29, July 17, 2024
20.04-1
Procedures for Developing the Care Plan
A member's Care Plan will be developed as part of the
						process of applying to receive services under the ORC waiver. The process for
						applying is as follows:
A.
Choice Letter:
The process begins by the member signing and
					 submitting a "choice letter" to the Office of Aging and Disability Services
					 (OADS) requesting services under the ORC waiver. The choice letter is a form
					 that DHHS sends to individuals who may be eligible for services under this
					 section requesting that the individual indicate their preference between
					 receiving services in an institutional setting (such as a nursing facility) or
					 receiving services in a community setting under this section.
B.
Application:
After receiving
					 the choice letter, the DHHS Care Monitor will meet with the member and guardian
					 or legal representative (where applicable) and complete the initial ORC
					 application. If the member appears to qualify and is interested in Money
					 Follows the Person/ Homeward Bound MFP/HB, the member will be referred for
					 MFP/HB determination for Money Follows the Person/ Homeward Bound MFP/HB.
					 Enrollment and Transition coordination through MFP/HB will be provided per
					 Money Follows the Person/ Homeward Bound MFP/HB program requirements as
					 outlined in the CMS approved Operational Protocol for Money Follows the Person/
					 Homeward Bound MFP/HB.
C.
Functional and Medical Assessments:
The Care Monitor will complete
					 the BMS 99 (or current functional assessment, as approved by the DHHS). In
					 addition, the Care Monitor will request the MED assessment to be completed by
					 the ASA.
D.
Safety/Risk
					 Assessment and Preliminary Care Plan:
The Care Monitor will work with
					 the member and guardian or legal representative (where applicable) and the
					 MFP/HB Transition Coordinator (where applicable) to complete DHHS-approved
					 safety/risk assessment and create a preliminary Care Plan to address all
					 safety/risks needs identified by DHHS-approved safety/risk assessment, the MED
					 assessment, and the BMS 99 (or current functional assessment approved by DHHS).
					 Each safety/risk need identified will require a plan to safely support the
					 member in the community with two forms of back-up support. The member will also
					 select the member's service package and preliminary budget.
E.
Selection of Residential Option and
					 Development of Final Care Plan:
The final Care Plan must be developed by
					 the member, the Care Monitor, guardian or legal representative (where
					 applicable), the MFP/HB Transition Coordinator (where applicable), the provider
					 for the Residential Option (where applicable) and the Care Coordinator. The
					 member will work with the Care Monitor, guardian or legal representative (where
					 applicable), and the MFP/HB Transition Coordinator (where applicable) to select
					 an approved residential option as outlined in 20.05-9 and to select a Care
					 Coordinator as outlined in 20.05-2. Once the residential option (where
					 applicable) and Care Coordinator are selected, the provider for Care
					 Coordination and Home Support or Personal Care (where applicable) will assist
					 the member in developing the final Care Plan including the budget, selection of
					 services, and safety/risk plan. The final Care Plan must:
i. Include people chosen by the individual;
ii. Provide necessary information
					 and support to ensure that the individual directs the process to the maximum
					 extent possible, and is enabled to make informed choices and
					 decisions;
iii. Be timely and occur
					 at times and locations of convenience to the individual.
F.
Signatures:
In order for the
					 final Care Plan to be approved, the Care Plan must include signatures of (1)
					 the member, or guardian, where applicable, and (2) the Care
					 Coordinator.
G.
Department
					 Review and Approval:
All services must be Prior Authorized by OADS.
					 Prior to implementation or start of residential services, the Care Plan must be
					 reviewed and approved by OADS, and OADS must determine that the member is
					 eligible for services as outlined in Section 20.03-1, 2 and 3.
H.
Utilization Review:
All Care
					 Plans must be reviewed and approved by OADS. OADS makes the determination that
					 the member continues to be eligible for services as outlined in 20.03-1, 2 and
					 3.