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-12 - Consumer Directed Attendant Services › Subsection 144-101-II-12.04 - AMOUNT AND DURATION OF SERVICES

Current through 2024-29, July 17, 2024
The Department or its ASA, consistent with these rules,
						determines the plan of care and the number of hours of covered services for
						each new member prior to the start of services, and for each established
						member, as his or her scheduled re-assessment comes due. 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.
MaineCare coverage of services under this Section is
						contingent upon eligibility determination prior to service delivery and
						consistent with these rules. Beginning and end dates of a member's medical
						eligibility period must correspond to the beginning and end dates for MaineCare
						coverage for these services.
The ADL Task Time Allowances in the attached Appendix A
						reflect the time normally allowed to accomplish the listed tasks. The ASA will
						use these allowances when authorizing a member's authorized plan of care on the
						care plan summary in the MED form and this plan will be reflected in the
						service plan. If these times are not sufficient, when considered in light of a
						member's unique circumstances, as identified and documented by the ASA, the ASA
						may make an adjustment as long as authorized hours do not exceed the limits
						established for the member's assessed level of care.
Services under this Section will be reduced, terminated,
						suspended or denied by the Department, the ASA or the Service Coordination
						Agency if any of the following situations occur:
A.
Termination/Denial of
					 Services
1. The member exceeds the
					 applicable Level I, II or III established limits.
2. The member declines these services;
3 A significant change occurs in
					 the member's medical, functional, or cognitive status and the ASA or the
					 Service Coordination Agency determines that appropriate services can no longer
					 be provided under this Section;
4.
					 The ASA or the Service Coordination Agency determines that the health and
					 welfare of the member is endangered should he or she remain at home receiving
					 services under this Section;
5. The
					 Service Coordination Agency documents that the member fails to manage an
					 attendant consistent with requirements of this Section;
6 The member enters a hospital, nursing
					 facility, private non-medical institution, or Intermediate Care Facility for
					 Individuals with Intellectual Disabilities as an inpatient;
7. The member is receiving personal care
					 services under Section
					 96, "Private Duty Nursing and
					 Personal Care Services"; Section
					 19, "Home and Community- Benefits
					 for the Elderly and Adults with Disabilities"; Section 63 "In-Home and
					 Community Support Services for Elderly and Other Adults" (HBC); or any other
					 section of the
MaineCare Benefits Manual
where personal care
					 services are a covered service;
8.
					 The member resides in assisted housing, a residential care facility, PNMI or
					 supported living arrangement where personal care services are already
					 provided;
9. The member is not
					 medically or financially eligible to receive Title XIX or XXI
					 benefits;
10. The Service
					 Coordination Agency documents the member does not comply with the authorized
					 plan of care;
11. The member gives
					 fraudulent information to the Department, ASA or Service Coordination
					 Agency;
12. The Department, ASA, or
					 the Service Coordination Agency documents the member or someone living in or
					 frequently visiting the household harasses, threatens, or endangers the safety
					 of individuals delivering services;
13. The ASA or Service Coordination Agency
					 documents the member is directing the personal attendant to complete tasks not
					 included as covered services in Section
					 12.05;
14. The member does not meet the eligibility
					 criteria under Section
					 12.03; or
15. Services have been suspended for more
					 than sixty (60) days. At that time the member's eligibility for these services
					 will be terminated and will require a new assessment by the ASA and determined
					 medically eligible prior to services restarting.