94.04-1
Informing and Periodicity
MaineCare will inform all members about the availability
of Early and Periodic Screening, Diagnosis and Treatment within sixty (60)
calendardays of their enrollment in MaineCare and in the case of families that
have not utilized such services, annually thereafter.
MaineCare will notify members that a health assessment
visit is due by the first of the month in which visits are due according to the
MaineCare Bright Futures periodic health assessment schedule (Appendix
1).
94.04-2
Special
Assistance for Members under Age 21
MaineCare will provide the following assistance to
members.
A. Arrange or schedule
appointments for services or treatment for problems found as a result of a
health assessment visit.
B. Find a
MaineCare provider.
C. Arrange
transportation.
D. Make referrals
for follow-up by the Maine Department of Health and Human Services, Centers for
Disease Control and Prevention, Public Health Nursing (PHN) staff or nursing
staff under contract with the Centers for Disease Control and Prevention to
perform PHN functions for, but not limited to, the following reasons. The
child:
1. does not have a primary care
provider;
2. is significantly
behind in his/her immunizations;
3.
is missing appointments with his or her provider(s); or
4. needs a repeat blood lead test.
Providers may use the MaineCare Bright Futures health
assessment form to request a referral to the Centers for Disease Control and
Prevention or may call or fax the Health Care Management Unit of MaineCare
Services.
E.
Help with issues identified as a result of a health assessment visit when
requested by the provider.
F.
Provide information in alternative formats such as Braille or provide
interpreter services for members who are deaf/hard of hearing or who are
non-English or limited English speaking.
94.04-3
Home Visits for Children Age
Two and Under
A. MaineCare will pay
for home visits for families with a child age two and under who is enrolled in
MaineCare when one or more of the following risk criteria exist:
1. The infant or child:
a. had a birth weight under 2500
grams;
b. was born pre-term, i.e.
under 37 weeks; and/or
c. has a
chronic illness or disability.
2. The infant or child's:
a. mother is single and was under 20 years of
age at the time of birth; or
b.
parents have been diagnosed with mental retardation.
3. There is a history of substance abuse in
the household, excluding nicotine use or abuse.
Home visit services are direct services provided by a
registered nurse or other trained professional in accordance with a plan of
care approved by the child's physician, physician's assistant or advanced
practice registered nurse. Home visit services are not case management.
MaineCare will pay for up to 2.5 hours of direct services provided in the home
per family per month.
B. Staff at the following clinics, agencies,
and centers may provide services through home visits, ambulatory care clinics,
home health agencies, Federally Qualified Health Centers and Rural Health
Clinics. Staff providing services through home visits must work within the
scope of their licenses and any additional restrictions of the agencies
employing them. Prior to doing a home visit, these staff members must:
1. develop a plan of care based on the risk
criterion being addressed,
2. make
sure the plan is approved by the child's physician, physician's assistant, or
advanced practice registered nurse, and
3. request and receive prior authorization
from the MaineCare Prior Authorization (PA) Unit of MaineCare
Service.
