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-21 - Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder
Subsection 144-101-II-21.08 - DURATION OF CARE

Universal Citation: 10 ME Code Rules ยง 144-101-II-21.08

Current through 2024-38, September 18, 2024

21.08-1 Voluntary Termination- A Member who currently receives the benefit, but no longer wants to receive the benefit will be terminated, after DHHS receives written notice from the Member that he or she no longer wants the benefit.

21.08-2 Involuntary Termination- DHHS will give written notice of termination to a Member at least ten (10) 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 is determined to be financially or medically ineligible for this benefit or MaineCare;

B. The Member is determined to be a nursing facility resident, ICF/IID, psychiatric hospital, or hospital resident for six months;

C. The Member is 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 abide by the Person-Centered Service 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 Person-Centered Service Plan.

F. The Member has not received at least one waiver service in a thirty (30) day period; or

G. The annual cost of the Member's services under this waiver exceeds two hundred percent (200%) of the state-wide average annual cost of care for an individual in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), as determined by the DHHS, unless the Member is authorized to exceed this limit pursuant to the Exceptions process in this rule and/or another ADA modification.

21.08-3 Termination from Participation as a MaineCare Provider: Pursuant to Chapter I of the MaineCare Benefits Manual, the provider must notify the Department in writing of the intent to terminate its participation in the MaineCare program, at least thirty (30) days prior to the effective date of termination for non-emergency terminations and seven (7) days prior to emergency terminations. Additionally, providers shall notify all Members receiving Section 21 services from the provider in writing of the provider's intent to terminate its MaineCare Provider status (and thus terminate all MaineCare services) following the same timeline for non-emergency and emergency terminations noted above.

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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