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-29 - Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
Subsection 144-101-II-29.08 - DURATION OF CARE

Universal Citation: 10 ME Code Rules ยง 144-101-II-29.08

Current through 2024-38, September 18, 2024

Each member receiving services under this Section is eligible for as many covered services as are authorized by DHHS in the member's personal plan. Services are authorized to meet the needs identified in the member's most recent assessment, subject to limits on covered service components specified elsewhere in this Section.

29.08-1 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.

29.08-2 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, psychiatric hospital, hospital, or ICF/IID 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 Personal 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 Personal 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 fifty percent (50%) of the state-wide average annual cost of care for an individual in an ICF/IID, as determined by the DHHS.

29.08-3 Provider Termination from the MaineCare program- The provider must provide the member and DHHS thirty (30) days written notice prior to the effective date of termination.

29.08-4 After a member is determined eligible for this waiver, if there is any one (1) month period during which the member does not receive a waiver service, the case manager must include a note in the record indicating;

A. The reason a waiver service was not provided,

B. Whether the member continues to need services provided in the waiver.

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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