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-18 - RULES GOVERNING IMPLEMENTATION OF THE TRADE ADJUSTMENT ASSISTANCE PROGRAM
Subsection 144-101-II-18.08 - DURATION OF CARE

Universal Citation: 10 ME Code Rules ยง 144-101-II-18.08

Current through 2024-38, September 18, 2024

18. 08-1 Voluntary Termination- A member who currently receives the benefit, but no longer wants to receive the benefit, will be terminated from waiver services, after DHHS receives written notice from the member that he or she no longer wants the benefit.

18. 08-2 Involuntary Termination- DHHS will give written notice of termination from waiver services to a member at least thirty (30) days prior to the effective date of the termination, providing the reason for the termination, and the member's right to appeal such decision. A member may be terminated from this benefit for any of the reasons listed below:

A. The member has been determined to be financially or medically ineligible for this benefit;

B. The member has been determined to be a nursing facility resident or ICF/IID resident without an approved Care Plan to return to his or her home;

C. The member has been determined to be receiving MaineCare services from another Home and Community Based Waiver benefit;

D. The member is no longer a resident of the State of Maine;

E. The health and welfare of the member can no longer be assured because:
1. The member or immediate family, guardian or caregiver refuses to participate in Care Planning or abide by the Care Plan or other benefit policies;

2. The home or home environment of the member becomes unsafe to the extent that benefit services cannot be provided without risk of harm or injury to the member or to individuals providing covered services to the member; or

3. There is no approved Care Plan.

F. The member has not received at least one service in a consecutive thirty (30) day period;

G. The estimated annual cost of the member's services under the waiver is equal to or less than one hundred percent (100%) of a blended rate of the statewide average annual cost of care for individuals in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) and Nursing Facility Brain Injury units, as determined by DHHS (the blended rate being the sum of 20% of the statewide average annual cost of care in an ICF/IID and 80% of the statewide average annual cost of care in a Nursing Facility Brain Injury unit).

18. 08-3 Suspension of Services- Services may be suspended for up to thirty (30) days if requested by the member and approved by DHHS. If such circumstances extend beyond 60 days, the member's service coverage under this section will be terminated and the member will need to be reassessed to determine medical eligibility for these services.

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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