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-28.04 - COVERED SERVICES
Current through 2024-38, September 18, 2024
A covered service is a service provided to a member for which payment may be made under the MaineCare Program, and through contract with DHHS. Assessment and treatment are covered services when provided to an eligible member by an approved staff so long as the services are medically necessary as defined in this section. Treatment is provided in the home and/or community in either individual or group settings and requires prior authorization and utilization review.
28.04-1 Treatment Services for Children with Cognitive Impairments and Functional Limitations are medically necessary treatment services for members under the age of twenty one (21). Treatment services are designed to retain or improve functional abilities which have been negatively impacted by the effects of cognitive or functional impairment and are focused on behavior modification and management, social development, and acquisition and retention of developmentally appropriate skills. Services include problem solving activities in order to help the member develop and maintain skills and abilities necessary to manage his or her behavioral health treatment needs, learning the social skills and behaviors necessary to live with and interact with other community members and independently, and to build or maintain satisfactory relationships with peers or adults, learning the skills that will improve a member's self-awareness, environmental awareness, social appropriateness and support social integration, and learning awareness of and appropriate use of community services and resources.
28.04-2 Specialized Services for Children with Cognitive Impairments and Functional Limitations are medically necessary, evidence based treatment services for members under the age of twenty one (21), that utilize behavioral interventions designed to improve socially significant behaviors and developmentally appropriate skills to a measurable degree. Services include problem solving activities in order to help the member develop and maintain skills and abilities necessary to manage his or her behavioral health treatment needs, learning the social skills and behaviors necessary to live with and interact with other community members and independently, and to build or maintain satisfactory relationships with peers or adults, learning the skills that will improve a member's self-awareness, environmental awareness, social appropriateness and support social integration, and learning awareness of and appropriate use of community services and resources.
*The Department is seeking, and anticipates receiving, approval from CMS for this Section. Pending approval, these changes will be effective.
28.04-3 *BCBA Services are services performed by a BCBA in connection with Specialized Services for Children with Cognitive Impairments and Functional Limitations (Specialized Services). The BCBA is responsible for the supervision and delivery of the Specialized Services. BCBA services are defined as the following:
Providers may request additional hours/units beyond the stated limitations above when deemed medically necessary through supported documentation and Prior Authorization through the Department or its Authorized entity.
