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-91 - Physician Services
Subsection 144-101-II-91.01 - DEFINITIONS

91.01-1 Behavioral and Physical Health Integration means the care a Member experiences as a result of a team of primary care and behavioral health providers, working together with Members and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.

91.01-2 Billing Month is from the 21st of a month to the 20th of the following month, e.g. March 21st to April 20th.

91.01-3 Community Care Team (CCT) means a multi-disciplinary, community-based and/or practice-integrated care management team that has completed an application and been approved by MaineCare to provide CCT covered services.

91.01-4 Community Health Worker (CHW) means a trained health worker who applies their unique understanding of the community's experience, socio-economic needs, language and/or culture to advocate for individual and community needs and acts as a bridge between providers and individuals to promote health, reduce disparities, and improve service delivery. CHWs are distinguished from other health professionals in that they are hired primarily for their understanding of the populations and communities they serve, conduct outreach a significant portion of the time, and have experience providing services in community settings.

CHW training shall include CHW core competencies as defined by The Community Health Worker Core Consensus Project (see https://www.c3project.org/roles-competencies) or evidence of a Maine CHW certification or registration, if such a designation becomes active in the State of Maine.

91.01-5 Electronic Health Record (EHR) is a systematic collection of electronic health information about individual patients, including Members. It is a record in digital format that is capable of being shared across different health care settings including via a Department-designated health information exchange(s) (HIE), a Department-designated, network-connected enterprise-wide information system(s), and other information networks or exchanges. An EHR supports clinical EHR functions, such as intake, clinical care, task management, and case management where appropriate, and it has HL7 interoperability capabilities to support the electronic sharing of portions of the patient's record.

91.01-6 Housed means a Member's status when they have either moved into an apartment, home, or other domicile or in a long-term placement in an assisted living or waiver home setting.

91.01-7 Housing Outreach and Member Engagement Provider (HOME Provider) is a specialized CCT approved by MaineCare to provide housing outreach and Member engagement services for eligible Members with Long-term Homelessness.

91.01-8 Long-term Homelessness means residing in a place not meant for human habitation, an emergency shelter, a temporary outdoor shelter, a homeless shelter, or a setting of institutional care or incarceration for a minimum total of 180 days out of either the last 365 days or two (2) out of the last three (3) 365-day periods. Stays in a setting of institutional care or incarceration may not account for more than 90 of the Member's total homeless days in any one 365-day period. If Long-term Homelessness criteria was met, as defined above, prior to incarceration then the Member is considered to have Long-term Homelessness post incarceration.

91.01-9 Member means a MaineCare member.

91.01-10 Plan of Care is a patient-centered plan that describes, coordinates, and integrates all of a Member's clinical information and clinical and non-clinical health care-related needs and services. The Plan of Care shall include Member health care data, Member health goals, and the services and supports necessary to achieve those goals. Services and supports may include, but not be limited to, prevention, wellness, specialty care, behavioral health, transitional care and coordination, and social and community services.