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-28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations
Subsection 144-101-II-28.02 - ELIGIBILITY FOR SERVICE
Universal Citation: 10 ME Code Rules ยง 144-101-II-28.02
Current through 2024-38, September 18, 2024
To be found eligible for Rehabilitative and Community Support Services For Children With Cognitive Impairments and Functional Limitations, a member must be under twenty-one years of age and meet all of the following criteria:
A. Individuals must meet the financial eligibility criteria as set forth in the MaineCare Eligibility Manual (MEM).
B. All services must be medically necessary pursuant to Chapter I, Section 1.02-4.D. of the MaineCare Benefits Manual and identified in the ITP.
C. Specific Eligibility Criteria
1. The member must have a completed
multi-axial evaluation with an Axis I or Axis II behavioral health diagnosis
using the most recent Diagnostic and Statistical Manual of Mental
Health Disorder or an Axis I diagnosis from the most recent
Diagnostic Classification of Mental Health or
Developmental Disorders of Infancy and Early Childhood Manual
(DC-03); AND
a. Have a functional assessment
administered within one (1)year prior to the date of the referral documenting
functional impairment measured as two (2) standard deviations below the mean on
the composite score or have one point five (1.5) standard deviations below the
mean on the composite score and two standard deviations below the mean in the
communication or social domain sub score of the most current version of the
Vineland Adaptive Behavior
http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=Vineland-II,
or the Adaptive Behavioral Assessment Scales
http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8004-507&Mode=summary,
or
b. have a functional assessment
administered within one (1) year prior to the date of the referral documenting
functional impairment measured as two (2) standard deviations below the mean on
the Developmental Quotient of the Battelle Developmental Inventory or have 1.5
standard deviations below the mean on the Developmental Quotient and two (2)
standard deviations below the mean on in the Personal-Social, Adaptive,
Communication, or Cognitive subscales.http://www.riverpub.com/products/bdi2/index.html,
or
c. have a functional assessment
administered within one (1) year prior to the date of the referral documenting
functional impairment measured as two (2) standard deviations below the mean on
the composite Adaptive Score of the Bayley Scales of Infant and Toddler
Development or have 1.5 standard deviations below the mean on the composite
Adaptive Score and two (2) standard deviations below the mean on the Social or
Communication domain or Cognitive, Language or Social Emotional Subscale.
http://www.pearsonassessments.com/haiweb/cultures/en-us/productdetail.htm?pid=015-8027-264
or
d. other functionally equivalent
tools approved by DHHS and other clinical assessment information obtained from
the member and family; or
2. A member aged birth through five (5)
years, who has a diagnosis from a physician (including psychiatrist) of a
specific congenital or acquired condition, and a written assessment by a
physician (including psychiatrist) that there is a significant probability that
because of that condition, the member will meet the functional impairment
criteria in (C)(1) above, later in life if medically necessary services and
supports are not provided to the member;
3. Family Participation is required in
treatment services to the greatest degree possible given the individual needs
as well as family circumstances.
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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