Code of Maine Rules, Section 144-101-II-96, Subsection 144-101-II-96.07 - POLICIES AND PROCEDURES | Code of Maine Rules

96.07-1 Eligibility Determination

Applicants for services under this Section must meet the eligibility requirements set forth in Section 96.02. An eligibility assessment, using the Department's approved MED assessment form, shall be conducted by the Department, the ASA, or the PDN provider, as applicable.

Eligibility for individuals under the age of 21, and for medication services or venipuncture services, and excluding all seeking services under the family provider services option, shall be determined by the PDN provider, in accordance with the requirements of Section 96.02 and the MED form.

These services require prior approval by the Department. All other PDN/PCS services, for Members age 21 and over, and those requesting services under the family provider service option, require eligibility determination and prior approval by the ASA.

Applicants ages 18 and over who meet the NF medical eligibility criteria also qualify for Home and Community Benefits. These benefits may provide a greater array and quantity of services than otherwise available under this Section 96; therefore, applicants must be assessed to determine whether they qualify for NF level of care.

Members are prohibited from receiving Home and Community Benefits and services under this Section simultaneously, except as described in Section 96.05(L).

A. If financial eligibility for MaineCare has not been determined, the applicant, family Member or guardian, must be referred to the regional Office for Family Independence, concurrent with the relevant medical eligibility determination process.

B. The Department, or its ASA, shall conduct a medical eligibility assessment using the Department's approved MED assessment form. The individual conducting the assessment shall be a registered nurse and will be trained in conducting assessments and developing an authorized plan of care with the Department's approved tool. The RN assessor's findings and scores recorded in the MED form shall be determinative in establishing eligibility for services and the authorized plan of care.

C. The PDN provider shall develop a nursing plan of care, which shall be reviewed and signed by the Member's physician. It shall include the personal care and nursing services authorized by the ASA or the Department, and the nursing plan signed by the Member's physician.

D. The anticipated costs of services under this Section to be provided under the authorized plan of care must conform to the limits set forth in Section 96.03 and 96.06.

E. An individual's specific needs for medical services must be reviewed and approved by the Member's physician at least every 62 days, and so documented in the medical record and nursing plan of care by the RN.

1. Applicants, age 21 and over, and Members requesting services under the family provider service option, who meet the eligibility criteria for PDN services, as set forth in Section 96.02, and as documented by the Department's approved MED assessment form, shall:

a. Be assigned, by the ASA, to the appropriate level of care, and receive an authorized plan of care based upon the scores, timeframes, findings and covered services recorded in the MED assessment. The covered services to be provided in accordance with the authorized plan of care shall:

1) not exceed the established financial caps;

2) be authorized by the Department or its ASA; and

3) be under the direction of the Member's physician for the nursing plan of care.

b. The assessor shall approve an eligibility period for the Member, based upon the scores, timeframes and needs identified in the MED assessment for the covered services, and the assessor's clinical judgment. The eligibility period shall not exceed 12 months.

c. Except for those Members who qualify under Level IX, the assessor shall notify the Service Coordination Agency within two business days of the medical eligibility determination and authorization of the plan of care. For those Members who are eligible under Level IX, the assessor shall forward the completed assessment and plan of care to the Licensed Assisted Living Agency, as defined in § 96.01-28.

2. Members under age 21, excluding those requesting services under the family provider service option.

a. Services require prior approval by the Department. The Department shall approve an eligibility period, not to exceed one year.

b. An individual under age 21, who does not meet the eligibility criteria for PDN services as set forth in Section 96.02, may be reviewed under Prevention, Health Promotion, and Optional Treatment Services. If the provider determines that services are medically necessary pursuant to the criteria of Prevention, Health Promotion, and Optional Treatment Services, then services shall be provided in accordance with a plan of care and billed under this Section, adhering to all applicable financial caps unless authorization to exceed that cap has been granted by the Department as outlined under Section 96.03(A).

c. If a provider determines that any of the requested services, for an individual under age 21, are medically necessary, but are not available from that provider, the provider shall notify the family in writing (in the Department's approved notice format) which services are not available from that provider. A copy of the letter shall be sent to the Department's Prevention, Health Promotion, and Optional Treatment Services staff, and Prevention, Health Promotion, and Optional Treatment Services staff shall offer to assist the Member in locating other providers.

d. If the provider determines that the PDN/PCS services are not medically necessary, then the provider shall notify (using a notice format approved by the Department) the family in writing of which services will be provided and which services will not be provided, or provided only on a reduced basis. The notice shall contain an understandable explanation of the reasons and inform them of their appeal rights and of Prevention, Health Promotion, and Optional Treatment Services. A copy of any denial/reduction notice shall be sent to the Prevention, Health Promotion, and Optional Treatment Services. Prevention, Health Promotion, and Optional Treatment Services will then offer to assist the family to see what other services may be provided to meet the child's needs.

e. The private duty nursing services provider shall develop a nursing plan of care and an authorized plan of care.

f. The anticipated costs of services to be provided under the plan of care must conform to the limits set forth in Section 96.03. The costs of physical therapy, occupational therapy, speech and hearing services shall not be included in the calculation of either the average annual cost of institutional services or the cost of PDN services required by the individual.

g. The PDN/Personal care services provider shall obtain the signature of the physician on the plan of care or a physician's order for private duty nursing and personal care services and for the medical treatment plan. This shall be made available to the Department or its Authorized Entity upon request. Services must also be authorized by the Department or its Authorized Entity.

h. For services to individuals under age 21, as well as individuals classified for venipuncture services and medication services, but excluding those receiving services under the family provider service option, the eligibility assessment form and the plan of care shall be maintained in the Member's medical record, available upon request for review by the Department. The provider must submit a copy of the medical eligibility determination form to the Department.

i. The provider shall be responsible for assuring that the plan of care shall not exceed the financial cap established by the Department.

96.07-2 Redetermination of Eligibility

A. For all Members under this Section, in order for the reimbursement of services to continue uninterrupted beyond the approved eligibility period, a reassessment and prior approval of services is required and must be conducted at least 5 days prior to and no later than the reclassification date.

For Members under the age of 21, as well as Members classified for venipuncture services and medication services, but excluding those receiving care under the family provider service option, the MED assessment tool shall be submitted to MaineCare Services, Quality Improvement Division within 72 hours of completion of the MED form, for initial assessments or reassessments. MaineCare payment ends with the reassessment date, also known as the eligibility end date.

B. An individual's specific needs for medical services are reviewed at least every 62 days, and so documented in the medical record and nursing plan of care by the RN.

96.07-3 Family Provider Service Option. All requirements of Section 96 apply to the family provider service option unless exempted specifically in this sub-Section, or elsewhere in this Section. This option allows, under certain conditions specified below, a MaineCare Member (or a family Member on his or her behalf,) to solely manage the Member's authorized personal support services, if the Member (or a family Member,) is a family provider agency. The management of the personal support services includes: hiring, firing, training, maintaining records and scheduling the PSS(s). This service option is not available to those Members who receive services based on Level IX eligibility criteria.

A. The following provisions apply:

1. The MaineCare Member, or his or her family Member (see below), as applicable, must be age 21 years or older, and register with the Department as a personal care agency, pursuant to the Department's "Rules and Regulations Governing In-Home Personal Care and Support Workers".

2. A family Member related by blood, marriage or adoption, or a significant other in a committed partnership, must register as the personal care agency in order to manage the personal care services on behalf of the MaineCare Member, if the Member does not have the ability, or does not meet the required standards for cognitive capacity, or otherwise does not desire to manage his or her own care.

3. The MaineCare Member must meet the minimum standards for cognitive capacity as defined in Section 96.01-26, in order to be the family provider agency.

4. For children and youth under age 21 years, a parent or guardian may be the family provider agency, if the child has all required medical eligibility determination assessments performed by the ASA and management performed by the Service Coordination Agency, as is required of all other Members using this family provider service option. (Note: under other Sections of this rule, children's services do not go through the ASA and the Service Coordination Agency.)

5. Participation is subject to the approval (and ongoing approval) of the Service Coordination Agency.

6. The family provider agency may manage personal care services for up to two family Members.

7. The family provider agency may hire a family Member to deliver the personal care services, with the exception of the MaineCare Member's spouse, or the parent (including stepparent) of a minor child who is a MaineCare Member. Refer to Federal regulation 42 CFR 440.167, and the State Medicaid Manual, Section 4480, "Personal Care Services" (prohibits the coverage of personal care services delivered by these legally responsible family Members.)

8. The adult who is registered as the personal care agency will not be paid to provide care to the Member.

9. A Member's guardian will not be paid to provide care to the Member.

B. The family provider agency must:

1. check the Maine Registry of Certified Nursing Assistants and Direct Care Workers and conduct a criminal history background check for any individual hired as a personal care assistant and not employ an individual who is prohibited from employment under Title 22 MRSA §1717(3);

2. use a fiscal intermediary payroll entity that has been approved by the Department;

3. receive authorization from the ASA, including an authorized plan of care;

4. implement the authorized plan of care;

5. comply with the Department's quality assurance oversight activities and visits; failure to comply will result in termination of the Member's participation in the family provider service option.

C. As part of the family provider services option, the Service Coordination Agency must:

1. check the Maine Registry of Certified Nursing Assistants and Direct Care Workers and conduct a criminal background check on the individual who registers as a personal care agency; and

2. manage the Member's authorized professional services (i.e., RN services); and

3. assist the Member with contacting a fiscal intermediary.

D. As part of the family provider services option, the Assessing Services Agency must serve as the Department's authorized entity for Members under age 21 who are receiving services under the family provider services option as defined in Section 96.01-23.

96.07-4 Discharge Notification

A. A provider serving children under age 21, and Members receiving venipuncture services and medication services, must notify the Department within 48 hours of discharging a Member from care.

B. A provider serving Members age 21 and over must notify the Service Coordination Agency within 48 hours of discharging a Member from care.

96.07-5 ELECTRONIC VISIT VERIFICATION (EVV)

Effective January 1, 2020, providers of Private Duty Nursing Services and Personal Care Services must comply with the Maine DHHS Electronic Visit Verification ("EVV") system for standards and requirements. In compliance with Section 12006 of the 21st Century CURES Act ( P.L. 114-255), as codified in 42 U.S.C. § 1396b(l)(1), visits conducted as part of such services must be electronically verified with respect to: the type of service performed; the individual receiving the service; the date of the service; the location of the service delivery; the individual providing the service; and the time the service begins and ends. Providers may utilize the Maine DHHS EVV system at no cost, or may procure and utilize their own EVV system, so long as data from the provider-owned system can be accepted and integrated with the Maine DHHS EVV system and is otherwise compatible. Private Duty Nursing Level IX, care coordination, and skills training services are exempt from EVV compliance.

96.07-6 Professional and Other Qualified Staff

All professional staff must be conditionally, temporarily, or fully licensed as documented by written evidence from the appropriate governing body. All professional staff must provide services only to the extent permitted by qualified professional staff licensure. Services provided by the following staff are reimbursable under this Section.

A. Registered Professional Nurse

A registered professional nurse employed directly or through a contractual relationship with a home health agency or acting as an individual practitioner may provide private duty nursing services by virtue of possession of a current license to practice their health care discipline in the state in which the services are performed.

B. Psychiatric Registered Nurse

A registered professional nurse that is licensed by the state or province in which services are provided and has met requirements for approval to practice as an advanced practice psychiatric nurse or is certified as a psychiatric and mental health nurse by the appropriate national accrediting body.

C. Licensed Practical Nurse

A licensed practical nurse employed directly by or through a contractual relationship with a licensed home health agency may provide private duty nursing services by virtue of possession of a current license to practice their health care discipline in the state in which the services are performed provided they are supervised by a registered professional nurse.

D. Home Health Aide

Any home health aide employed directly by, or acting under a contractual relationship with, a licensed home health agency must have satisfactorily completed training for certified nurse assistants consistent with the rules and regulations of the Maine State Board of Nursing. Home health aides employed by a home health agency must also have satisfactorily completed an agency orientation as defined by the Regulations governing the Licensing and Functioning of Home Health Care Services and be listed on the Maine Registry of Certified Nursing Assistants and Direct Care Workers. The HHA must meet all applicable state laws and regulations as are currently in effect.

E. Certified Nursing Assistant

A CNA employed by, or acting under a contractual relationship with, a licensed home health agency must have satisfactorily completed training for certified nurse assistants consistent with, and receive supervision consistent with, the Rules and Regulations of the Maine State Board of Nursing and be listed on the Maine Registry of Certified Nursing Assistants and Direct Care Workers registry. The CNA must meet all applicable state laws and regulations as are currently in effect.

F. Certified Nursing Assistant/Medications

A CNA who meets the requirements in Section 96.06-4(E) above and has satisfactorily completed a Department-approved medication course for Certified Nursing Assistants, consistent with the Rules and Regulations of the Maine State Board of Nursing and be listed on the Maine Registry of Certified Nursing Assistants and Direct Care Workers.

G. Personal Support Specialist (PSS)

A PSS must be employed by, or acting under a contractual relationship with a licensed home health agency, registered personal care agency, or licensed assisted living agency, as defined in § 96.01-28, under contract with Office of Aging and Disability Services. The following requirements must be met:

1. Criminal background check and CNA and Direct Care Workers registry check. A provider agency must check the Maine Registry of Certified Nursing Assistants and Direct Care Workers and conduct criminal background checks for applicants for positions as PSSs, CNAs or home health aides and must not employ an individual who is prohibited from employment under Title 22 MRSA §1717.

2. Training. A provider agency must verify that a PSS meets one of the training and examination requirements below. An individual without the required training may be hired and reimbursed for delivering personal care services as long as the individual enrolls in a certified training program within sixty (60) days of hire and completes training and examination requirements within nine months of employment and meets all other requirements. If the individual fails to pass the examination within nine months, reimbursement for his or her services must stop until such time as the training and examination requirements are met. A PSS must: (meet one of the following):

a. Hold a valid certificate of training for nursing assistants or have official documentation of equivalent training as verified by the office of the Maine Registry of Certified Nursing Assistants and Direct Care Workers, and be currently listed on the Maine Registry of Certified Nursing Assistants and Direct Care Workers without any annotation that would prohibit that individual from employment; or

b. Hold a valid certificate of training, issued within the past three years, for nurse's aide or home health aide training which meets the standards of the Maine State Board of Nursing- nursing assistant training program; or

c. Pass the competency-based examination of didactic and demonstrated skills from the Department's approved personal support specialist curriculum if a CNA whose status on the Maine Registry of Certified Nursing Assistants has lapsed, or an individual who holds a valid certificate of training issued more than three years ago, for nurse's aide or home health aide training which meets the standards of the Maine State Board of Nursing nursing assistant training program. A certificate of training as a personal care assistant/personal support specialist will be awarded upon the successful passing of this examination; or

d. Hold a valid certificate of training as a personal support specialist/personal care assistant issued as a result of completing the Department-approved personal support specialist training curriculum and passing the competency-base examination of didactic and demonstrated skills. The training course must include at least 50 hours of formal classroom instruction, demonstration, return demonstration, and examination. Tasks covered under this Section must be covered in the training; or

e. Be a personal support specialist (PSS) who successfully completed a Department-approved curriculum prior to September 1, 2003. Such individuals will be grand fathered as a qualified personal care assistant/PSS; or

f. Obtain a waiver from the Department, the ASA, or the Service Coordination Agency. At their discretion, the Department, the ASA, or the Service Coordination Agency, may waive training requirements for Personal Support Specialists under the family provider service option if the PSS has provided services to the Member prior to July 1, 2004 under Section 12, "Consumer Directed Attendant Services" or the state funded Consumer Directed Home Based Care program, under Section 63, "In-home and Community Support Services" of the Office of Aging and Disability Services Policy Manual. Otherwise, PSSs under the family provider service option must meet the training and competency requirements described above.

3. New employee orientation

a. A PSS, newly hired by an agency, who meets the Department's PSS training requirements, must receive an agency orientation. The training and certification documents must be on file in the PSS's personnel file.

b. With the exception of family provider service option PSSs, a newly hired PSS who does not yet meet the Department's training and examination requirements must undergo an 8 hour orientation that reviews the role, responsibilities and tasks of the PSS. To meet the required eight hours for orientation an agency may choose to use job shadowing for a maximum of two (2) hours of the 8 hour time requirement. The orientation must be completed by the PSS prior to the start of delivering services. The PSS must demonstrate competency to the employing agency in all required tasks prior to being assigned to a Member's home, with the exception of health maintenance activities, where by a PSS can demonstrate competency via on the job training once being assigned to a member's home.

c. A family provider agency must provide adequate orientation for the PSS to meet the needs of the Member(s). Adequacy shall be determined by the Service Coordination Agency. The provision of orientation, including the specific dates and times of training, and the content matter of the orientation must be documented in the PSS's personnel record.

4. Provider agency responsibilities include, but are not limited to the following:

a. Assure that PSSs meet the training, competency, and other requirements of this Section. Maintain documentation of how each requirement is met in the PSS's personnel file, including: evidence of orientation, Maine Registry of Certified Nursing Assistants and Direct Care Workers check, and criminal background checks, and the verification of credentials including

b. Initial and Supervisory visits

i. Initial visit. A provider agency supervisor or representative must make an initial visit to a Member's home prior to the start of personal care services to develop and review with the Member the plan of care as authorized by the ASA on the care plan summary and as ordered by the care coordinator.

ii. Scheduled supervisory visits. Excluding the family provider service option, for Level III, IV, and V Members, A PSS employed by a provider agency must receive on-site supervision of the implementation of the Member's authorized plan of care by the agency employer at least quarterly to verify competency and Member satisfaction with the PSS performance of the care plan tasks. For Level I and II Members, on-site supervision must be at least once every 6 months along with quarterly phone calls to the Member. More frequent or additional on-site supervision visits of the PSS is at the discretion of the provider agency as governed by its personnel policies and procedures.

iii. Supervisory visits for the family provider service option. PSSs reimbursed under the family provider service option must have on-site home supervisory visits by the Service Coordination Agency to evaluate the condition of the Member, implementation of the care plan, and the Member's satisfaction with the services. Failure to allow the Service Coordination Agency on-site visits is grounds for terminating reimbursement to the PSS worker or agency.

c. A provider agency must develop and implement written policies and procedures to ensure that PSSs do not smoke or consume alcohol or controlled substances in the Member's home or vehicle during work hours.

d. A provider agency must develop and implement written policies and procedures that prohibit abuse, neglect or misappropriation of a Member's property.

5. A family Member who meets the requirements of this Section may be a PSS and receive reimbursement for delivering personal care services, with the exception of the MaineCare Member's spouse, or the parent (including stepparent) of a minor child who is a MaineCare Member. Refer to Federal regulation 42 CFR 440.167, and the State Medicaid Manual, Section 4480, "Personal Care Services" (prohibiting the coverage of personal care services delivered by these legally responsible family Members.)

6. The Department has the authority to recoup funds for services provided if the provider agency does not provide required documentation to support qualifications of the agency, staff or services billed.

7. The Office of Aging and Disability Services has the responsibility of ensuring the quality of services and the authority to determine whether a PCA agency has the capacity to comply with all service requirements. Failure to meet standards must result in non-approval or termination of the contract for PCA services.

H. Fiscal Intermediary

For purposes of this subsection, the Fiscal Intermediary acts as an entity of the employer in accordance with Federal Internal Revenue Service Codes and procedures in matters related to the employment of support workers and purchases of other support services or goods. The Fiscal Intermediary Entity has an established contract with the Department, but is not a billable service under this Section. The use of a FI is required under the family provider service option.

I. Certified Residential Medication Aides (CRMAs) are allowed to administer medications to persons served by DHHS Licensed Assisted Housing Programs, as defined in 22 M.R.S.A. §7852, and other licensed facilities only after they have successfully taken a 40-hour class, passed a written test, and demonstrated medication administration competence to an RN. CRMA services are reimbursable under this Section only when employed by the Licensed Assisted Living Agency, as defined in § 96.01-28, that holds a valid contract with Office of Aging and Disability Services and the CRMA is working under the consultation of an R.N.

96.07-7 Member's Records

A. Authorized Entity, Service Coordination Agency and Direct Care Provider Records

There shall be a specific record for each Member which shall include the following:

1. Member's name, address, phone number, emergency contact, birth date;

2. The Member's medical eligibility determination form, release of information, authorized plan of care and copies of the eligibility determination notice and service authorizations issued by the Service Coordination Agency for Members over age 21;

3. Names and telephone numbers of the persons to call in case of an emergency or for advice or information. This information must be readily available to the HHAs, CNAs, PSSs, CRMAs and other in-home care workers;

4. The plan of care which specifies the tasks and the schedule of tasks to be completed by the PSS, CNA, HHA or CRMA and authorized services. Whenever a RN or LPN delivers services to more than one patient in the same setting, during the same visit (see Section 96.04(F) multiple patient nursing services) then this service must be described and documented in each Member's plan of care;

5. Entrance and exit times, and total hours spent in the home for each visit by each nurse, PSS, HHA, and CNA;

6. The number of medication passes performed by the CRMA for each Member under Level IX; and

7. Progress notes reflecting changes in the Member's condition, needs, communications with the Member, other information about the Member, and contacts with other involved agencies. Progress notes must be signed and dated by the person entering the note.

B. Authorized Plan of Care

1. The authorized plan of care must indicate the type of services to be provided to the Member, specifying who will perform the service, the number of hours per week, specifying the begin and end dates, and specifying the tasks and reasons for the service.

For all Members age 21 and over, excluding those eligible for medication services or venipuncture services, and for those Members under age 21 receiving care under the family provider service option, the Assessing Services Agency has the authority to determine and authorize the plan of care.

2. Members may receive Medicare covered services, as applicable, during the same time period they receive MaineCare covered PDN/PCS. The authorized plan of care must identify the types and service delivery levels of all other home care services to be provided to the Member whether or not the services are reimbursable by MaineCare. These additional home care services might be provided by such individuals as homemakers, personal care attendants and companions. These additional services shall include, but not be limited to, case management, home-delivered meals, physical therapy, speech therapy, occupational therapy, MSW services and hospice.

C. Nursing Treatment Plan of Care

The licensed home health agency provider or independent contractor shall obtain the signature of the physician at least every 62 days on the nursing plan of care and on the physician's orders for nursing treatments and procedures, medications, medical treatment plan, and the frequency and level of personal care services. (The physician orders and nursing plan of care may be combined into one document.) These shall be made available to the Department or its Authorized Entity upon request. Covered services must be authorized by the Department or the ASA. Content of the nursing treatment plan must include the following information:

1. All pertinent diagnoses, including mental status;

2. All services, supplies, and equipment ordered;

3. The level of care, frequency and number of hours to be provided;

4. Prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, safety measures to protect against injury, and any additional items the PDN services provider or physician choose to include. Orders for care must indicate a specific range in the frequency and number of hours. Orders may not be open-ended or "as needed;" and

5. The nursing plan of care and physician's orders for nursing treatments and procedures must be reviewed and signed by the Member's physician as required by the Department in this Section at least every 62 days.

D. Written Progress Notes for Services Delivered by a Direct Care Provider must contain:

1. The service provided, date, and by whom;

2. Entrance and exit times of nurse's, home health aides, certified nursing assistants and personal care assistant's visits and total hours spent in the home for each visit. Exclude travel time (unless provided as a service as described in this Section);

3. a written service plan that shows specific tasks to be completed and the schedule for completion of those tasks;

4. Progress toward the achievement of long and short-range goals. Include explanation when goals are not achieved as expected;

5. Signature of the service provider; and

6. Full account of any unusual condition or unexpected event, dated and documented.

E. Written Progress Notes for the Service Coordination Agency must contain:

1. Date and time of every contact with the Member and by whom; and

2. Progress toward the achievement of long and short range goals. Include explanation when the goals are not met as expected; and

3. Signature and date of the Service Coordination Agency staff Member entering the note; and

4. Full account of any unusual condition or unexpected event, dated and documented; and

5. All entries must be signed by the individual who performed the service. Authorized and valid electronic signatures are acceptable.

96.07-8 Program Integrity

All providers are subject to the Department's Program Integrity activities. Refer to Chapter I, "General Administrative Policies and Procedures", for rules governing these functions.

96.07-9 Member Appeals

A Member or applicant has the right to appeal in writing or verbally any decision made by the Department or its Authorized Entity, to reduce, deny or terminate services provided under this benefit. In order for a Member's services to continue during the appeal process, a request must be received by the Department within 10 days of the notice to reduce or terminate services. Otherwise, an individual has 60 days in which to appeal a decision. Members or applicants shall be informed of their right to request an Administrative Hearing in accordance with this Section and Chapter I of this Manual.

A. An appeal for Members or Applicants, aged 21 and over, and those under age 21 receiving care under the family provider services option, must be requested in writing or verbally to:

Director

Office of Aging and Disability Services

c/o Hearings

11 State House Station

Augusta, ME 04333-0011

B. For Members under the age of 21, and for all Members classified for medication services or venipuncture services, but excluding those receiving care under the family provider services option, an appeal must be made by the Member or his or her representative, in writing or verbally, for a hearing to:

Director

MaineCare Services

Department of Health and Human Services

11 State House Station

Augusta, Maine 04333-0011

For the purposes of determining when a hearing was requested, the date of the fair hearing request shall be the date on which the Director receives the request for a hearing. The date a verbal request for a fair hearing is made is considered the date of the request for the hearing. MaineCare Services may also request that a verbal request for an administrative hearing be followed up in writing, but may not delay or deny a request on the basis that a written follow-up has not been received.