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-12.05 - COVERED SERVICES

Universal Citation: 10 ME Code Rules § 144-101-II-12.05

Current through 2024-38, September 18, 2024

Covered services are available for members meeting the eligibility requirements set forth in Section 12.03. All covered services are subject to the limits in this Section. The authorized plan of care shall be based upon the member's assessment outcome scores recorded on the Department's Medical Eligibility Determination form, its definitions, time frames therein, and the task time allowances described in Appendix A.

Members who qualify are eligible for the following services:

A. Care Coordination Services. The provider of these services coordinates and implements the services in the Member's plan of care authorized by the ASA. In addition, the care coordinator performs the following functions:

1. ensures that authorized services are delivered according to the service plan;

2. provides resources to members to identify available service options and service providers, and answers questions related to the health and care of Members;

3. documents and takes appropriate action concerning any changes in the general health and welfare of the Member;

4. instructs the Member in his or her rights and responsibilities, including the obligations under this Section;

5. assesses the Member/attendant relationship, including whether attendant duties are being performed satisfactorily, whether attendant training is adequate or if additional training is needed;

6. takes appropriate action, including reporting to the Department, any evidence of public nuisance, substance abuse, harassment, neglect, exploitation, or fraud on the part of the attendant, Member, Member's household or visitor;

7. documents and investigates all complaints from any party within two (2) business days and resolving all complaints within thirty (30) days;

8. establishes and maintains Member files in accordance with requirements under 12.08-4;

9. Makes face-to-face contact with the member at least every 3 months. All other care coordination services provided can be done either face-to-face or through phone contact. See Section 12.06 for limits to this service.

B. Skills Training Services. These services provide instruction in management of attendant services. This includes instruction in recruiting, interviewing, selecting, training, scheduling, discharging, and directing a competent attendant in the activities in the authorized plan of care and obligations under this Section.

Providers of skills training must instruct each new eligible Member prior to the start of services. The provider must document that skills training has occurred within thirty (30) calendar days of the determination of medical eligibility.

The Skills Training provider may substitute a competency-based assessment in lieu of repeat instruction for Members having previously completed such training under an earlier eligibility period or from another provider of like services.

C. Personal Care Services (PCS). These services include services related to a member's physical requirements for assistance with the activities of daily living. Additionally, when authorized and specified by the Department or ASA in the authorized plan of care, PCS may include: IADLs and/or health maintenance activities, which are directly related to the member's plan of care. These tasks must be performed in conjunction with direct care to the member. IADLs and health maintenance activities are those activities that would otherwise be normally performed by the member if he or she were physically able to do so. It must also be established that there is no family member or other person available to assist with these tasks.

The Department is seeking and anticipates receiving CMS approval for this Section.

Pending approval, Covered Services will be provided as follows:

If a single provider of personal care services is providing this service to multiple Section 12 members in a single visit, the two (2) or three (3) person modifier shall be used, as outlined in Chapter III, Section 12, Allowances for Consumer-Directed Attendant Services.

Travel time only of an attendant in the course of delivering a covered service is allowed under this Section.

1. Activities of Daily Living (ADL) tasks include assistance with:

a. Bed mobility, transfer, and locomotion activities to get in and out of bed, wheelchair or motor vehicle;

b. Using the toilet and maintaining continence;

c. Health maintenance activities;

d. Bathing, including transfer;

e. Personal hygiene, which may include combing hair, brushing teeth, shaving, washing and drying face, hands, and perineum;

f. Dressing;

g. Eating, and clean up and h. Assistance with administration of medications, as directed by the member, for the member.

The ASA will use the allowances in Appendix A to determine the time necessary to complete authorized ADL tasks. 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 appropriate adjustment subject to limits and caps under this Section.

2. Instrumental Activities of Daily Living (IADLs)

a. All IADLs must be authorized and specified in the authorized plan of care. These tasks must be furnished in conjunction with direct care to the member and directed by the member. IADL tasks include assistance with:

i. grocery and prepared food shopping, assistance with obtaining medication to meet the member's health and nutritional needs;

ii. routine housework, including sweeping, washing and/or vacuuming of floors, cleaning of plumbing fixtures (toilet, tub, sink), appliance care, changing of linens, refuse removal;

iii. laundry done within the residence or outside of the home at a laundry facility;

iv. money management, as directed by the member for the member; and v. meal preparation and clean up.

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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