89.04-1
Member Identification
The MaineMOM provider shall identify members who are
potentially eligible for services under Section
89.03. The MaineMOM
provider will submit potentially eligible members to the Department or the
Department's Authorized Entity through a certification process to approve
services. Each member's eligibility must be based on a diagnosis rendered
within the past year from the date of the certification request.
89.04-2
Enrollment and
Duplication of Services
A.
Enrollment: The MaineMOM provider shall identify members for
services based on the service eligibility criteria. The provider shall give
potentially eligible members information about the benefits of participating in
MaineMOM services. The member can choose to receive services once confirmed
eligible. The Department, or its Authorized Entity, must approve members
through a certification process with the certification effective the earliest
date without risk of duplicative services. The member can choose not to
participate in MaineMOM services at any time by notifying the MaineMOM
provider, the Department, or its Authorized Entity, for certifications of
services.
B.
Duplication of
Services: As set forth in Section
89.09
(Reimbursement), the Department will not reimburse for duplicative services for
members. If the Department, or its Authorized Entity, determines the member is
receiving a duplicative service through a certification process, the member
chooses which service they want to receive. The Department, or its Authorized
Entity, will notify members that they cannot receive duplicative services and
will keep a record of documentation as to the members' choice of service. A
member may only be in one health home program at a time.
C.
Requests and Referrals:
Members may request MaineMOM services or be referred for services through the
Department's maternal and child health referral system. MaineMOM providers must
provide a referral contact at their service location to facilitate the
connection to services.
D.
Documentation of Consent: MaineMOM providers must retain
documentation of consent for all members in the member record. Consent
documentation must, at a minimum:
1. Indicate
that the individual has received information explaining the purpose of MaineMOM
services and the services provided; and
2. Indicate that the individual has consented
to receive the MaineMOM services and understands their right to choose, change,
or disenroll from their MaineMOM provider at any time.
89.04-3
ASAM Criteria
MaineMOM providers shall assess the appropriateness of
MaineMOM services in alignment with the ASAM level of care criteria. Members
must minimally meet ASAM Level 0.5 or Level I for individual, family, or group
outpatient services.
