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-107 - Psychiatric Residential Treatment Facility Services
Subsection 144-101-II-107.05 - COVERED SERVICES
Universal Citation: 10 ME Code Rules ยง 144-101-II-107.05
Current through 2024-38, September 18, 2024
107.05-01 Active Treatment: PRTFs must provide active psychiatric treatment, including all the following:
A. Assessment
and evaluation, including review of CCON team documents, to be completed in
accordance with Section 107.07-07.A.;
B. Medical supervision seven days per week
and 24 hours per day;
C. Intensive
psychiatric monitoring and intervention, to include medication management and
medication administration:
1. Medication
Management sessions must occur at least once per week;
D. Behavioral and/or rehabilitative
therapies, the specific modality to be described in the member's Treatment
Plan. Therapy must include at a minimum, the following:
1. Individual Therapy, at least two (2) hours
weekly;
2. Group Therapy, at least
one (1) hour daily; and
3. Family
Therapy, at least two (2) hours weekly;
E. Comprehensive and individualized discharge
planning, to be commenced upon admission to the PRTF and meeting the
requirements described in Sections 107.05-04 and 107.07-07 below;
F. Crisis planning and
intervention;
G. Development of a
Positive Behavioral Support Plan (PBSP) as described in 107.07-08.B;
H. Case management;
I. All transportation services;
J. Personal care, activities of daily living
services, and instrumental activities of daily living services, and;
K. Room and board.
107.05-02 Development and Periodic Revision of the Treatment Plan as described in Section 107.07-07 of this policy.
107.05-03 Ancillary Services: When medically necessary, PRTFs must assure the provision of ancillary services to members enrolled in the PRTF. Ancillary services as described below are billed pursuant to their appropriate section of policy and are as follows:
A.
Occupational Therapy
Services are covered pursuant to regulations outlined in
MaineCare Benefits Manual, Section
68, Occupational Therapy Services
and provided by or under the direction of providers who meet the qualifications
in accordance with MaineCare Benefits Manual, Section
68, Occupational Therapy Services
and acting within his or her scope of practice under Maine State Law.
B.
Physical Therapy Services are
covered pursuant to regulations outlined in MaineCare Benefits
Manual, Section
85, Physical Therapy Services and
provided by or under the direction of providers who meet the qualifications in
accordance with MaineCare Benefits Manual, Section
85, Physical Therapy Services and
acting within his or her scope of practice under Maine State Law.
C.
Speech and Hearing Services
are covered pursuant to regulations outlined in MaineCare Benefits
Manual, Section
109, Speech and Hearing Services
and provided by or under the direction of providers who meet the qualifications
in accordance MaineCare Benefits Manual, Section
109, Speech and Hearing Services
and acting within his or her scope of practice under Maine State Law.
D.
Interpreter Services are
covered pursuant to regulations outlined in Chapter I, Section 1.06-3 of the
MaineCare Benefits Manual.
E.
Medical Services: to address
any existing or newly diagnosed physical health conditions when medically
necessary.
F. Board Certified
Behavior Analyst consultation with Prior Authorization.
107.05-04 Discharge Planning
A. Discharge planning must be included in the
Treatment Plan and be considered a vital component of the member's
care.
B. The member and the
member's natural supports, including school personnel, and community providers
must be considered in the development of the discharge plan. The member's
family or guardian must be involved in the development of the discharge
plan.
C. As part of the discharge
planning requirements, PRTFs must ensure the member has a minimum of a
seven-day supply of prescribed medication and a written prescription for
medication to last through the first outpatient visit in the community with a
prescribing provider.
D. Prior to
discharge, the PRTF must identify a prescribing provider in the community and
schedule an outpatient visit. Documentation of the medication plan and
arrangements for the outpatient visit must be included in the medical record
for the member.
E. If medication
has been used during the PRTF treatment of the member, but is not needed
following discharge, the reason the medication is being discontinued must be
documented in the medical record for the member.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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