Subsection 144-101-II-2.02 - ELIGIBILITY FOR CARE2.02-1General Financial Eligibility Requirements Individuals must meet financial eligibility criteria as set forth in the MaineCare Eligibility Manual . Some members may have restrictions on the type and amount of services they are eligible to receive.
2.02-2Specific Eligibility Requirements Members who are financially eligible must also meet specific eligibility requirements to determine medical necessity of AFC services, as determined by the MDS-ALS assessment tool. The MDS-ALS assessment must show the member's need for assistance or cueing with a minimum of two ADLs.
2.02-3Determination of EligibilityA. MaineCare will cover services only when an individual is determined by the Department or its authorized agent to be both medically and financially eligible for MaineCare. For each individual seeking MaineCare coverage of AFC services, the provider shall: 1. Verify the Department's determination of the individual's financial eligibility for MaineCare, and check for dates of eligibility. If financial eligibility has not been determined, the provider shall refer the applicant, or his/her authorized representative, to the local regional DHHS office if he/she is not a MaineCare member. Providers should also see MaineCare Benefits Manual , Chapter I for information regarding retroactive eligibility. The provider shall inform the local DHHS office when a person will be moving into the facility and will need financial assistance to pay for his or her care. The provider shall do this whether or not the individual already receives MaineCare and/or SSI benefits. 2. Complete an MDS-ALS within thirty (30) days of admission and maintain the completed assessment tool in the member's record.3. Notify the local regional DHHS office when the member has been admitted. The local DHHS office must also be notified at the time of discharge.4. Submit a valid MDS-ALS assessment for the member in order for the Department to compute the member's classification group resource weight necessary for payment. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-2, subsec. 144-101-II-2.02