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-28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations › Subsection 144-101-II-28.02 - ELIGIBILITY FOR SERVICE

Current through 2024-29, July 17, 2024
To be found eligible for Rehabilitative and Community
						Support Services For Children With Cognitive Impairments and Functional
						Limitations, a member must be under twenty-one years of age and meet all of the
						following criteria:
A. Individuals
					 must meet the financial eligibility criteria as set forth in the
MaineCare Eligibility Manual
(MEM).
B. All services must be medically necessary
					 pursuant to Chapter I, Section 1.02-4.D. of the
MaineCare Benefits
					 Manual
and identified in the ITP.
C.
Specific Eligibility Criteria
1. The member must have a completed
					 multi-axial evaluation with an Axis I or Axis II behavioral health diagnosis
					 using the most recent
Diagnostic and Statistical Manual of Mental
					 Health Disorder
or an Axis I diagnosis from the most recent
Diagnostic Classification of Mental Health
or
Developmental Disorders of Infancy and Early Childhood Manual
(DC-03); AND
a. Have a functional assessment
					 administered within one (1)year prior to the date of the referral documenting
					 functional impairment measured as two (2) standard deviations below the mean on
					 the composite score or have one point five (1.5) standard deviations below the
					 mean on the composite score and two standard deviations below the mean in the
					 communication or social domain sub score of the most current version of the
					 Vineland Adaptive Behavior
http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=Vineland-II
,
					 or the Adaptive Behavioral Assessment Scales
					 http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8004-507&Mode=summary,
					 or
b. have a functional assessment
					 administered within one (1) year prior to the date of the referral documenting
					 functional impairment measured as two (2) standard deviations below the mean on
					 the Developmental Quotient of the Battelle Developmental Inventory or have 1.5
					 standard deviations below the mean on the Developmental Quotient and two (2)
					 standard deviations below the mean on in the Personal-Social, Adaptive,
					 Communication, or Cognitive subscales.
http://www.riverpub.com/products/bdi2/index.html
,
					 or
c. have a functional assessment
					 administered within one (1) year prior to the date of the referral documenting
					 functional impairment measured as two (2) standard deviations below the mean on
					 the composite Adaptive Score of the Bayley Scales of Infant and Toddler
					 Development or have 1.5 standard deviations below the mean on the composite
					 Adaptive Score and two (2) standard deviations below the mean on the Social or
					 Communication domain or Cognitive, Language or Social Emotional Subscale.
http://www.pearsonassessments.com/haiweb/cultures/en-us/productdetail.htm?pid=015-8027-264
or
d. other functionally equivalent
					 tools approved by DHHS and other clinical assessment information obtained from
					 the member and family; or