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-91.04 - MEMBER ELIGIBILITY FOR HOME SERVICES
Current through 2024-38, September 18, 2024
There are three (3) HOME service tiers: Intensive, Stabilization, and Maintenance. Members shall first meet the Intensive Tier criteria to receive HOME covered services. Once Intensive Tier eligibility is established, the HOME Provider shall assess Members for meeting Stabilization and Maintenance Tier criteria to ensure appropriate reimbursement. The Member's service tier may cycle back and forth between each tier, as indicated by the eligibility criteria.
Documentation of the Member's criteria for movement between tiers shall be retained in the Member's record. The expected intensity level of the covered services differs in each tier, but the covered services remain the same.
To be eligible for any HOME Provider service Tier, Members must meet the below eligibility criteria for one of the tiers and have at least two (2) chronic conditions or one (1) chronic condition and be at risk for a second chronic condition, in accordance with 91.03-1 and 93.03-2.
91.04-1 Intensive Tier: Member Eligibility
For HOME Provider Intensive Tier services, Members must:
91.04-2 Stabilization Tier: Member Criteria
For HOME Provider Stabilization Tier services, Members must:
91.04-3 Maintenance Tier: Member Criteria
For HOME Provider Maintenance Tier services, Members must:
