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-17.08 - POLICIES AND PROCEDURES
Universal Citation: 10 ME Code Rules ยง 144-101-II-17.08
Current through 2024-38, September 18, 2024
17.08-1 Assessments. The following policies and procedures apply to covered services related to the assessment of a member, as described in Section 17.08-1(B):
A. If the member seeking Community
Support Services is in a crisis/outreach situation, it may not be necessary or
possible for the assessment to cover all of the areas generally covered in an
assessment. An exception to the scope of the assessment may be made by a
supervisory mental health professional and recorded in the member's record. A
complete Community Support Services assessment must be developed as soon as
clinically feasible, but no later than thirty (30) days.
B. The clinical components of an assessment
will be:
1. Performed by the appropriate
mental health professionals acting within the scope of their license;
2. Coordinated by a Community Support
Provider.
C. The member
or guardian seeking Community Support Services will be an integral part of the
assessment and will provide essential information. The member's family or
significant other also may be involved, unless such involvement is not feasible
or contrary to the wishes of the member or guardian.
D. A Community Support Provider shall develop
a comprehensive ISP as defined in 17.04-1(E) within thirty (30) days of
application of a member for covered services 17.04-1 (Community Integration),
17.04-2 (Community Rehabilitation Services),17.04-3 (Assertive Community
Treatment-ACT). For all other Section
17 Covered Services, an ISP as
specified in
17.01-12 must be developed within
thirty (30) days of acceptance. These timeframes must be met unless there is
documentation in the member's file that supports a clinical reason why the
assessment was not done within thirty (30) days. In these cases, the assessment
and the ISP or treatment plan must be developed as soon as clinically
feasible.
E. Assessments must
indicate the member's diagnosis and the name and credentials of the clinician
who determined the diagnosis.
17.08-2 Individual Support Plan (ISP). The following apply to covered services related to a member's individual support plan described in 17.04-1.C and 17.01-11:
A. The ISP must be based on the results of
the assessment;
B. All identified
clinical services indicated in the ISP must be approved by a Mental Health
Professional;
C. To help the member
achieve the objectives of his or her ISP, the Community Support Provider shall
provide information and support to the member or guardian and, unless not
feasible or contrary to the wishes of the member or guardian, to his or her
family or significant other;
D. To
ensure that the member has access to specific services, supports, and resources
identified in his or her ISP, the Community Support Provider shall provide
coordination and advocacy and by working directly with providers, advocates,
and informal support systems;
E. To
ensure that the ISP is being followed and is appropriate to a member's needs,
the Community Support Provider shall:
1.
Review ISP to determine efficacy of the services and natural supports and to
formulate changes in the plan as necessary; and
2. Evaluate the effectiveness of the ISP with
the member or guardian and, unless not feasible or contrary to the wishes of
the member or guardian, with other providers and the member's family or
significant other; and
F.
The ISP as defined in 17.04-1(E) must be reviewed and approved in writing by a
mental health professional within the first thirty (30) calendar days of
application of the member for those services and every ninety (90) calendar
days thereafter, or more frequently as indicated in the ISP. An ISP related to
17.04-4 (Daily Living Support Services), 17.04-5 (Skills Development Services),
17.04-6 (Day Support Services) must be reviewed and approved in writing by a
Mental Health Professional within the first thirty (30) days of
acceptance.
17.08-3 Records. The Community Support Provider shall maintain an individual record for each member receiving covered services. The record must minimally include:
A. Name, birthdate, and
MaineCare identification number;
B.
Pertinent available medical information regarding the member's
condition;
C. The member's written
ISP;
D. Documentation of each
service provided, including the date of service, the type of service, the goal
to which the service relates, the duration of the service, the progress the
member has made towards goal attainment and the signature and credentials of
the individual performing the service.
17.08-4 Member Appeals. Any decision made by DHHS or its Authorized Entity to terminate, reduce, or suspend MaineCare services will be provided to the member in writing with notice of hearing rights as described in Chapter I of the MaineCare Benefits Manual.
17.08-5 Protections for Adults with Serious and Persistent Mental Illness
If the member is an Adult with a Serious and Persistent Mental Illness (i.e., the member meets the eligibility criteria in 17.02-3) and is receiving Community Integration Services or Assertive Community Treatment (ACT) Services reimbursed under Section 17,as identified in the member's Individual Support Plan, then the provider must:
A. Obtain written approval from
the Director of the Office of Behavioral Health (OBH) or designee prior to
terminating services to that member;
1.
Written approval is not required in cases where the terminating provider has
successfully facilitated a member's transfer, with the member's consent, to a
new provider;
B. If
approved by OBH, issue a thirty (30) calendar day advanced written termination
notice to the member prior to termination of the member's services. In cases
where the member poses a threat of imminent harm to persons employed or served
by the provider, the Director of the Office of Behavioral Health(or designee)
may approve a shorter notification for termination of services;
C. Assist the member in obtaining clinically
necessary services from another provider prior to discharge or termination; and
D. Accept referrals through the
Department-defined referral process within seven (7) calendar days. Only in
cases where providers have received written approval of declination from OBH
may a referral be declined.
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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