C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-102, subsec. 144-101-II-102.05
A covered service is a service for which payment to a provider is permitted under this Section of the MaineCare Benefits Manual. The types of rehabilitative services that are covered for eligible individuals are the following:
A qualified neuropsychologist (defined in Section 102.08-5(B)) and/or a licensed physician who is Board certified, or otherwise Board eligible, in either physical medicine and rehabilitation or neurology, must conduct and supervise a Clinical Assessment, face-to-face with the member, in collaboration with the interdisciplinary team, as part of the admission process. The findings of the Clinical Assessment form the basis for the specific rehabilitation goals and describe the types and frequencies of each service and the expected outcomes and timeframes. The Clinical Assessment must indicate the degree of functional impairment, assess the member's potential for physical and/or behavioral and/or cognitive rehabilitation, include the BIAT and the health and safety assessment and meet the requirements of Section 102.08-7(A)(1). Reimbursement for brain injury Clinical Assessment services must not exceed eight (8) hours (32 units) of service, per member.
MaineCare will reimburse for the Clinical Assessment to confirm the diagnosis of brain injury, even if the member is not found eligible for services under this Section. These members should be provided with other service recommendations, as appropriate, to address needs identified by the Clinical Assessment. The provider will also conduct a Reassessment once every six months. All Clinical Assessments will be completed with thirty (30) days of initiation of services. If the Clinical Assessment cannot be completed within this time frame, case record documentation will reflect the reason and plans for completion.
Integrated treatment includes the rehabilitation of physical, cognitive, psychological, and behavioral issues including restorative and compensatory approaches. These treatments are provided on a 1:1 basis by licensed/certified medical/rehabilitative personnel within a coordinated team process. Care coordination is an integral component of this process.
Integrated treatment includes interventions for biopsychosocial factors associated with brain injury: disruptive and non-compliant behaviors, cognitive unawareness, health and physically related risk-taking behaviors, and emotional adjustment to brain injury. These treatments are provided by licensed/certified medical/rehabilitative personnel and their extenders within a coordinated team process. Care coordination is included.
Integrated treatment includes compensatory interventions and treatment focused on functional improvement and reinforcement of self care and home management. These treatments are provided on a 1:1 and group basis by licensed/certified medical/rehabilitative personnel and their extenders within a coordinated team process. Care coordination is included. Group services are coded with HQ.
Integrated treatment includes compensatory interventions and treatment focused on functional improvement and reinforcement of community and work reintegration. These treatments are provided on a 1:1 and group basis by licensed/certified medical/rehabilitative personnel and their extenders within a coordinated team process. Care coordination is included. Group services are coded with HQ.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-102, subsec. 144-101-II-102.05