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-17.04 - COVERED SERVICES
Current through 2025-13, March 26, 2025
The following are covered services reimbursable under MaineCare. All services delivered will ensure that member voice and choice are reflected in all Plan development:
17.04-1 Community Integration Services. Community Integration Services includes a biopsychological assessment of the member, an evaluation of community services and natural supports needed by the member who satisfies the eligibility requirements of Section 17.02, and rapport building through assertive engagement and linking to necessary natural supports and community services while providing ongoing assessment of the efficacy of those services.
Community Integration Services involve active participation by the member or guardian. The services also involve active participation by the member's family or significant other, unless their participation is not feasible or is contrary to the wishes of the member or guardian. These services are provided as indicated on the ISP. These services may not be provided in a group.
A Community Support Provider furnishing Community Integration Services must employ a certified MHRT/C who performs the following:
17.04-2 Community Rehabilitation Services. Community Rehabilitation Services support the development of the necessary skills for living in the community, and promote recovery, and community inclusion. Services include individualized combinations of the following, and are delivered by a team, with primary case management for eachmember assigned to one team member. Community Integration Services as defined in Section 17.04-1 of the MaineCare Benefits Manual Daily Living Support Services as defined in Section 17.04-4 of the MaineCare Benefits Manual Skills Development Services as defined in Section 17.04-5 of the MaineCare Benefits Manual
Services must be available twenty-four (24) hours a day, seven (7) days a week. Staff must be at a work site twelve (12) hours per day and on call the remainder.
A minimum of one (1) face-to-face contact per day, seven (7) days per week must be provided.
The team providing services must be provided by a team made up of MHRT/1's and MHRT/C's, delivering services within the scope of their certifications. The minimum staffing ratio for the team is one (1) staff person to six (6) members. Replacement staff and supervisors are excluded from calculation of the staffing ratio.
Services must be prior authorized by the Department or an Authorized Entity and be appropriate to meet the clinical and rehabilitation needs of the member.
17.04-3 Assertive Community Treatment. Assertive Community Treatment (ACT) provides individualized intensive integrated services that are delivered by a multi-disciplinary team of practitioners and are available twenty-four (24) hours a day, every day, three hundred and sixty-five (365) days a year. ACT services are delivered primarily in the community and not in an office based setting. Assertive interventions, including street outreach, are employed by the team as appropriate. ACT teams must provide at least on average, per member, three (3) face-to-face contacts with the member per week. There may be exceptions to the three (3) face-to-face contact requirements and the member's record must clearly document why the contacts did not occur, such exceptions may include;
If the member is seen as not tolerating or benefitting from the level of intensity of ACT services, the member should be re-evaluated for a different service or level of care.
ACT teams must assume clinical responsibility for all members on the team and must offer all of the following services and support:
Individual assessment and individual support plan development; Development and implementation of a comprehensive crisis management plan and provision of follow-up services, including emergency face-to-face contact, if necessary, to assure services are delivered and the crisis is resolved; Use and promotion of informal and natural supports to assist the member with integration in the community; Contacts with the member's parent, guardian, other family members, and providers of services or natural supports, as appropriate, to ensure continuity of care and coordination of services within and between inpatient and community settings; Individual, group and family outpatient therapy, supportive counseling or problem-solving activities in order to maintain and support the member's recovery and provide the support necessary to help the member manage the symptoms of the member's illness and co-occurring substance use disorder; Linking and evaluating the efficacy of services and natural supports, and formulating changes to the individual support plan as necessary; Medication services, including medication management and administration, which minimally includes:17.04-4 Daily Living Support Services. Daily Living Support Services are designed to assist a member to maintain the highest level of independence possible. The services provide personal supervision and therapeutic support to assist members to develop and maintain the skills of daily living. The services help members remain oriented, healthy, and safe. Without these supportive services, members likely would not be able to retain community tenure and would require crisis intervention or hospitalization. These services are provided to members in or from their homes or temporary living quarters in accordance with an individual support plan. Support methods include modeling, cueing, and coaching. The services do not include specialized crisis support services as described in the MaineCare Benefits Manual,Chapter II, Section 65, Behavioral Health Services, subsection 65.06-1, Crisis Resolution. Daily Living Support Services are provided by an MHRT-1, except that when Daily Living Support Services includes administration and supervision of medication, a CRMA must provide that portion of the services.
Daily Living Support Services do not include:
A Community Support Provider who furnishes services to a member under Sections 17.04-1 or 17.04-3 may also contract with DHHS to furnish Daily Living Support Services to the member concurrently. Requests for these concurrent services must be approved by DHHS or an Authorized Entity, in accordance with Section 17.09-2(B). If approved, the provider shall review the member's ISP, developed pursuant to 17.04-1(E), at least every ninety (90) days to determine whether the Daily Living Support Services should be continued. DHHS or an Authorized Entity must determine at least every ninety (90) days whether to authorize continuation of the services upon request in accordance with Section 17.09-2(B).
A Community Support Provider may furnish Daily Living Support Services to a member, even though the provider is not concurrently furnishing services to the member under Sections 17.04-1 or 17.04-3 or Section 92. In that event, another Community Support Provider who is under contract with DHHS to provide services under Sections 17.04-1 or 17.04-3 or Section 92 must review the member's ISP, developed pursuant to 17.04-1(E) or Section 92 at least every ninety (90) days and determine whether the Daily Living Support Services should be continued. DHHS or an Authorized Entity must determine at least every ninety (90) days whether to authorize continuation of the services, upon request in accordance with Section 17.09-2(B). Daily Living Support Services may not be provided concurrently to the member under Section 17.04-5, Skills Development Services.
17.04-5 Skills Development Services. Skills Development Services involve face-to-face contact with the member, with or without family or non-professional caregivers, that restore and improve the member's skills and abilities essential to independent living (i.e. self-care and daily life management). Services may be provided to an individual or in a group setting and are targeted to enhance access to community resources, with natural supports, increase independence to promote successful community integration. Skill enhancement is provided through structured interventions for attaining goals identified in the ISP. Progress on goals will be reviewed at least every ninety (90) days to determine the efficacy of the services and natural supports and to formulate changes in the plan as necessary.
Skills Development Services are provided by an MHRT/C and when Skills Development includes administration and supervision of medication, a CRMA must provide that portion of the services.
When Skills Development Services are related to supporting employment for a member, they must be billed with the code for "Ongoing Support to Maintain Employment." Such services are focused on managing behaviors or symptoms that interfere with an individual's ability to obtain or retain employment. Services include instruction in dress, grooming and socially acceptable behaviors in the workplace, supportive contacts on or off the job, instruction and skill development on how to request workplace accommodation, how to solve problems and resolve coworker conflict.
When Skills Development Services are provided to a member for ten (10) or fewer hours per week, continuation of the services beyond one (1) year requires, upon request, prior authorization by DHHS or an Authorized Entity -, in accordance with Section 17.09-2(B). When services are provided for more than ten (10) hours per week, DHHS or an Authorized Entity must review continuation of the services every ninety (90) days in accordance with Section 17.09-2(B). Skills Development may be provided in a group when facilitated by qualified staff and comply with 17.10-2. Skills Development Services may not be provided concurrently to the member with Section 17.04-4.
17.04-6 Day Supports Services. Day Supports Services, formerly known as "day treatment," focus on training designed to assist the member in the acquisition, retention, or improvement of self-help, socialization, and adaptive skills. These services take place in an agency environment. They are offered most often in a group setting and are provided by certified MHRT/Cs under the supervision of, or are co-facilitated by, a mental health professional as defined in 17.07-1. Day Supports Services are covered for one (1) year from the start date of the services unless, upon request of the provider, DHHS or an Authorized Entity - approves continuation of the services in accordance with Section 17.09-2(B).
17.04-7 Interpreter Services. Interpreter Services for MaineCare members who are hearing impaired or who do not speak English may be reimbursed in accordance with Chapter I, Section 1.06-3, of the MaineCare Benefits Manual.