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-46 - Psychiatric Hospital Services › Subsection 144-101-II-46.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
46.01-1
Active Treatment
Active treatment means implementation of a professionally
						developed and supervised individual plan of care that is designed to achieve
						the member's discharge from inpatient services at the earliest time
						possible.
46.01-2
Authorized Agent
Authorized Agent means the organization authorized by
						the Department of Health and Human Services (DHHS) to perform specified
						functions including, but not limited, to prior authorization and/or utilization
						review pursuant to a signed contract or other approved signed agreement.
46.01-3
Community
					 Care
Community Care means services not provided in a hospital
						setting and provided to a member in his/her place of residence, regardless of
						whether the member is residing with biological family, adoptive family, foster
						parents, therapeutic parents or in Intensive Temporary Out of Home
						Treatment.
46.01-4
Emergency Psychiatric Inpatient Admission
An emergency psychiatric inpatient admission means any
						admission of a patient who requires immediate psychiatric hospitalization due
						to the patient's risk of harm to self and/or others and the patient's inability
						to manage in a less restrictive environment without further regression.
46.01-5
Inpatient
					 Services
Inpatient Services in this Section means services
						furnished in a psychiatric hospital for patients who have been admitted to the
						hospital for twenty four (24)-hour-a-day acute psychiatric care. MaineCare only
						covers inpatient psychiatric services for members under age twenty-one (21) or
						age sixty five (65) and older.
46.01-6
Mental Health Clinician
A Mental Health Clinician means a Physician,
						Psychiatrist, Clinical Psychologist, Licensed Clinical Social Worker (LCSW),
						Licensed Master Social Worker, Licensed Master Social Worker Conditional
						Clinical (LMSW-CC), Licensed Clinical Professional Counselor (LCPC), Licensed
						Professional Counselor (LPC), Licensed Marriage Family Therapist (LMFT),
						Advanced Practice Registered Nurse Psychiatric and Mental Health Practitioner
						(APRN-PMH-NP), or an Advanced Practice Registered Nurse Psychiatric and Mental
						Health Clinical Nurse Specialist (APRN-PMH-CNS) when practicing within their
						scope of licensure to make a diagnosis.
46.01-7
Outpatient Services
Outpatient services means a planned combination of
						diagnostic, treatment and rehabilitative services provided to mentally or
						emotionally disturbed members in the hospital setting on a less than
						twenty-four (24) hour a day basis. Outpatient services are intended to provide
						support and facilitate a more integrated and independent level of functioning
						in the community to members with psychiatric disorders.
46.01-8
Partial Hospitalization
					 Services
Partial Hospitalization Services means a supervised
						rehabilitative-oriented treatment by a mental health clinician lasting more
						than two (2) hours but less than twelve (12) hours each day in a psychiatric
						hospital that provides a combination of evaluative, diagnostic, treatment and
						rehabilitative services to persons with psychiatric problems.
46.01-9
Psychiatric Hospital
Psychiatric Hospital means a hospital that is primarily
						engaged in providing psychiatric services for the diagnosis, treatment and care
						of persons with mental illness. A psychiatric hospital must be licensed as a
						psychiatric hospital by the Department of Health and Human Services
						(DHHS).
46.01-10
Serious Emotional Disturbance
Serious Emotional Disturbance (SED) means when a member
						has a mental health, emotional or behavioral diagnosis, under the current
						edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM),
						that has lasted for or can be expected to last for at least one (1) year, and
						is at risk for more restrictive placement, including but not limited to,
						psychiatric hospitalization, as a result of this condition for which other less
						intensive levels of service have not been effective (e.g. traditional
						outpatient services).
46.01-11
Developmental Disorders
					 Unit
An inpatient psychiatric unit that solely serves members
						under the age of 21 with developmental disorders and staffed by a child
						psychiatrist and psychologist with specific training and expertise in the
						assessment and treatment of this population. This unit utilizes an
						evidence-based, bio-behavioral approach based upon intensive data collection
						and observable measures; and utilizes a multi-disciplinary team approach to
						address speech pathology, occupational therapy, special education, nursing and
						social work needs.