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-17 - Community Support Services
Subsection 144-101-II-17.01 - DEFINITIONS
Current through 2024-38, September 18, 2024
For purposes of Section 17, the following words have the following meanings:
17.01-1 Authorized Entity means an entity authorized by the Department of Health and Human Services (DHHS) to perform specified functions pursuant to a signed contract or other approved signed agreement.
17.01-2 Certified Employment Specialist means an individual who has completed an Association of Community Rehabilitation Educators (ACRE) approved course - or other employment specialist training approved by DHHS and maintains certification.
17.01-3 Certified Intentional Peer Support Specialist (CIPSS) means an individual who has completed the DHHS Office of Behavioral Health(OBH)curriculum for CIPSS and receives and maintains certification.
17.01-4 Certified Rehabilitation Counselor means an individual certified by the Commission on Rehabilitation Counselor Certification.
17.01-5 Clinician is an individual appropriately licensed or certified in the state or province in which he or she practices, practicing within the scope of that licensure or certification, and qualified to deliver treatment under this Section. A clinician includes the following: Licensed Clinical Professional Counselor (LCPC); Licensed Clinical Professional Counselor-conditional (LCPC-conditional); Licensed Clinical Social Worker (LCSW); Licensed Master Social Worker-conditional (LMSW-conditional clinical); physician, psychiatrist; Psychiatric and Mental Health Nurse Practitioner (PMH-NP); Psychiatric and Mental Health Clinical Nurse Specialists (PMH-CNS); Adult Nurse Practitioner (ANP); Family Nurse Practitioner (FNP); Physician Assistant (PA); or licensed psychologist.
17.01-6 Community Support Service means a rehabilitative service that is provided in the context of a supportive relationship, pursuant to an individual support plan that promotes a person's recovery, and integration of the person into the community, and sustains the person in his or her current living situation or another living situation of his or her choice.
17.01-7 Community Support Provider means an agency that is licensed by DHHS, holds a valid contract with DHHS, and has received a rate-setting letter from DHHS to provide Community Support Services to members eligible for covered services under Section 17.02. Please refer to Section 17.05-2 for detail on multiple providers of Community Support Services. DHHS will contract with all agencies that are willing and able to meet the standard DHHS requirements for providing community support services and the standard contract requirements.
17.01-8 Covered Service means a Community Support Service for which Community Support Providers can be reimbursed under the MaineCare Program.
17.01-9 Certified Residential Medications Aide (CRMA) means an individual who holds a current certification from DHHS as a Certified Residential Medication Aide.
17.01-10 Homeless person means a person sleeping in places not meant for human habitation, such as cars, parks, sidewalks, and abandoned or condemned buildings, or is sleeping in homeless shelters.
17.01-11 Individual Support Plan (ISP) is developed for and with a member receiving Community Support Services by a Community Support Provider. An Individual Support Plan (ISP):
17.01-12 Level of Care Utilization System (LOCUS) is Level of Care Utilization System for Psychiatric and Addiction Services, of the American Association of Community Psychiatrists.
17.01-13 LOCUS Certified Assessor is an individual certified for LOCUS assessment by DHHS upon successful completion of prescribed LOCUS training.
17.01-14 MHRT-1 means an individual who has received Mental Health Rehabilitation Technician-1 certification from DHHS to provide service under Section 17.04-4 or Section 97, "Private Non-Medical Institutions", MaineCare Benefits Manual.
17.01-15 MHRT/C means an individual who has received Mental Health Rehabilitation Technician/Community certification from DHHS.
17.01-16 Natural Supports means personal associations and relationships typically developed in the community that enhance the quality and security of life for people. Natural Supports include, but are not limited to: family relationships; friendships reflecting the diversity of the neighborhood and the community; association with fellow students or employees in regular classrooms or work places; and associations developed through participation in clubs, organizations, and other civic associations.
17.01-17 Peer means an individual who is receiving or who has received services related to the diagnosis of a major mental illness and is willing to self-identify with peers on this basis in the community.
17.01-18 Primary Diagnosis for the purposes of this policy, primary diagnosis shall mean the diagnosis that results in qualifying functional deficits.
17.01-19 Prior Authorization (PA) means the process of obtaining DHHS prior approval based on eligibility and medical necessity for a service. All services in this Section except Specialized Group Services require prior authorization by the Department or an Authorized Entity. After submitting a PA request, the provider will receive prior authorization with a description of the type, duration and costs of the services authorized. The provider is responsible for providing services in accordance with the prior authorization and the requirements in this section. The prior authorization number is required on the CMS 1500 claim form. All extensions of services beyond the original authorization must be prior authorized by this same procedure.
17.01-20 Substance Use Disorder Counselor means an individual who is licensed by the Maine State Board of Alcohol and Drug Counselors as a Certified Alcohol and Drug Counselor (CADC), Licensed Alcohol and Drug Counselor (LADC); or an Advanced Practice Registered Nurse (APRN), Licensed Physician (MD or DO), Physician Assistant (PA), Licensed Psychologist, Licensed Clinical Social Worker (LCSW), Licensed Clinical Professional Counselor (LCPC), or Licensed Marriage and Family Therapist (LMFT) who has at a minimum one (1) year of clinical experience providing substance use disorder treatment.
17.01-21 Utilization Review means a formal assessment of the medical necessity, efficiency and appropriateness of services and treatment plans on a prospective, concurrent or retrospective basis. The provider is required to notify the DHHS or an Authorized Entity prior to initiation of services in order for the Department or an Authorized Entity to begin utilization review.
