meeting various problems-in-living. Children and adolescents under the age of 18 may be evaluated on the , or C-GAS. 97.02-7 Medical Eligibility Criteria for Appendix D Child Care Facility Services are four models of PNMI services for Appendix D Child Care Facilities: Mental Retardation and Pervasive Developmental Disorder (PDD) Conditions: Child and Adolescent Intensive Temporary Behavioral Health Treatment in a Residential Setting There are two levels of PNMI services for children with mental retardation and/or PDD and other symptoms requiring this intensity of service. A child is eligible for only one level of service at a time. Initial prior authorization will not be given for more than thirty days at a time and continuing stay will be assessed at a minimum of every ninety days thereafter. All of the following criteria set forth below must be met, in addition to criteria for either Level I or Level II services, as detailed below. The child must have: An Axis I or II diagnosis from the most current version of the DSM, and A disorder that has lasted for at least six (6) months or is expected to last for at least one (1) year in the future, and A current need for therapeutic treatment or availability of a therapeutic on-site staff response on a twenty-four hour basis, and A disorder that is amenable to treatment in a residential setting, and even with intensive community intervention, including services and supports, there is significant potential that the child will be hospitalized, or there 97.02 ELIGIBILITY FOR CARE (cont.) is a clear indication that the child’s condition would significantly deteriorate and would require a higher model of service than can be provided in the home and community.
potential for harm to self or others either directly or as a consequence of being unable to maintain ADL’s and Children’s Habilitation Assessment Tool (CHAT) score of 35 or higher, or a Global Assessment Functioning (GAF) score of 40 or lower with description of specific symptoms justifying the score. 2. Child Mental Health Conditions: Child and Adolescent Intensive Temporary Behavioral Health Treatment in a Residential Setting There are two levels of PNMI services for children and adolescents with Mental Health Conditions. The child must meet all of the criteria set forth below: The child must have either an Axis I or II diagnosis from the most current version of the DSM, and The child’s disorder has lasted for at least six (6) months or is expected to last for at least one year in the future, and The has a current need for therapeutic treatment or availability of a therapeutic on-site staff response on a twenty-four hour basis, and The child’s disorder is amenable to treatment in a residential setting, and Even with intensive community intervention, including services and supports, there is significant potential that the child will be hospitalized, or there is a clear indication that the child’s condition would significantly deteriorate and would require a higher model of service than can be provided in the home and community. In addition, the child must meet the criteria below for Level I or Level II services: 97.02 ELIGIBILITY FOR CARE (cont.) Level I Criteria
constructive use of leisure time, money management and interpersonal relationship skills, all of which are considered services by MaineCare; - Clinical services, including individual and counseling; and - Opportunity for family involvement. The PNMI shall have twenty-four (24)-hour coverage by on-site trained staff (as required by Adult Mental Health Services) and include weekend coverage. Each PNMI shall provide at least one (1) hour per week of professional consultation to the clinical staff to ensure the well being of the members and to provide for the growth and development of the staff. This consultation may be either on a group or individual basis. The PNMI shall assure the availability of a transportation support system twenty-four (24)-hours a day, and shall maintain a written agreement for the provision of transportation between the facility and emergency care facilities. 97.08-2 Child Care Facilities A. General Description Responsibility for implementation of each member’s individual service plan shall rest with a licensed or certified clinical personnel or staff person operating within the scope of his/her license or certification under Maine law. Such clinical personnel or staff is responsible for the provision of direct services and for documented supervision of other qualified staff involved in implementing the service plan. Supervisory arrangements must be made in accordance with licensing and certification regulations. The health professional may be employed by the facility or engaged through a consultant contract or agreement. must provide all services pursuant to a written service plan based on an individualized assessment of the member made in accordance with 97.08 GENERAL DESCRIPTION OF THE FACILITY’S CLINICAL SERVICES (cont.) the Rules for the Licensure of Residential Child Care Facilities or the Rules for Licensure of Child Placing Agencies, whichever is applicable. Service must be developed, approved and signed in accordance with the Rules for Licensure of Residential Child Care Facilities or Rules for