20.05-1Assistive Technology Device and Services-Assistive technology device means an item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of members. Assistive Technology service means a service that directly assists a member in the selection, acquisition, or use of an Assistive Technology device. Assistive Technology includes: (A) the evaluation of the Assistive Technology needs of a member, including a functional evaluation of the impact of the provision of appropriate Assistive Technology Devices and appropriate Assistive Technology Services to the member in the customary environment of the member;(B) services consisting of purchasing, leasing, or otherwise providing for the acquisition of Assistive Technology Devices for members;(C) services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining/upkeep, repairing, or replacing Assistive Technology Devices;(D) coordination and use of necessary therapies, interventions, or services with Assistive Technology Devices, such as therapies, interventions, or services associated with other services in the Care Plan;(E) training or technical assistance for the member, or, where appropriate, the family members, guardians, advocates, or authorized representatives of the member;(F) training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of members; and(G) transmission of data required for use of the Assistive Technology Device via internet or cable utility. The components above are subject to the following limits:
* The Assistive Technology Device and services described above in paragraphs (B) and (C) are subject to a combined limit of $6,000.00 annually.
* The services described above in paragraphs (A), (D), (E) and (F) are subject to a combined limit of 32 units (8 hours) annually.
* The data transmission utility costs described above in paragraph (G) are limited to $50.00 per month.
Assistive Technology Services excludes services available under the State Plan.
20.05-2Care Coordination Services- consists of service that assist members in gaining access to needed waiver and other State Plan services, as well as medical, social, educational and other services, regardless of the funding source for the services to which access is sought. Care Coordination Services are provided by Care Coordinators. Care Coordinators are responsible for assisting the member to access and coordinate natural supports. Care Coordinators are responsible for the monitoring and assurance of the implementation of the Care Plan. This includes monitoring of the health, welfare and safety of the member. This service requires face-to-face contact between the Care Coordinator and the member, at a minimum, every thirty days. A member who has this service may not receive Section 13, Targeted Case Management under the State Plan.20.05-3Career Planning- Career Planning is a person-centered, comprehensive employment planning and direct support service that provides assistance for a waiver program participant to obtain, maintain, or advance in competitive employment or self-employment at or above the state's minimum wage. It is a focused, time limited service engaging a member in identifying a career direction and developing a plan for achieving competitive, integrated employment at or above the state's minimum wage. The outcome of this service is documentation of the member's stated career objective and a Career Plan used to guide individual employment support. This service assists in identifying skills, priorities, and capabilities determined through an individualized discovery process. This may include a referral to benefits planning, referral of assessment for use of assistive technology to increase independence in the workplace, development of experiential learning opportunities, and career options consistent with the member's skills and interests. Career Planning may be used in preparation to gather information to be used as part of a referral to Vocational Rehabilitation.Career planning furnished under the waiver may not include services available under a program funded under section 110 of the Rehabilitation Act of 1973 or under the Individuals with Disabilities Education Act ( 20 U.S.C. § 1401, et seq.).
Career Planning is limited to 60 hours annually, to be delivered in a six-month period. No two six-month periods may be provided consecutively. Career Planning services must have the long-term goal of individual, competitive, integrated employment for which the member is compensated at or above the minimum wage. In order to receive Career Planning services, the member's Care Plan must identify specific career goals and describe how the Career Planning services will be used to achieve those goals.
The service requires submission of the Career Plan at three (3) intervals to DHHS in order to ensure that the service is provided in a manner that will result in competitive, integrated employment or self-employment at or above the states minimum wage.
Career Planning services can be provided within a variety of community settings such as a Career Center or a local business.
20.05-4Communication Aids-consists of devices or services necessary to assist members with hearing, speech or vision impairments to effectively communicate with service providers, family, friends, and other community members. Communication Aids include:
(A) communicators (including repair and maintenance) such as direct selection, alphanumeric, scanning and encoding communicators, if not otherwise covered for reimbursement under other sections of the MaineCare Benefits Manual;(B) speech amplifiers, aids and assistive devices (including repair and maintenance) if not otherwise covered for reimbursement under other sections of the MaineCare Benefits Manual.20.05-5Community Support Services-consists of the assistance with acquisition, retention, or improvement in self-help, socialization and adaptive skills that takes place in a non-residential setting, separate from the member's private residence or other residential living arrangement; however this service can originate or terminate in the member's private residence or other residential living arrangement. Community Support Services expose the member to activities and environments designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice. Services are furnished 4 or more hours per day on a regularly scheduled basis for 1 or more days per week or as specified in the member's Care Plan. Meals provided as part of these services shall not constitute a "full nutritional regimen" (3 meals per day). Community Support Services focus on enabling the member to attain or maintain his or her maximum functional level and shall be coordinated with any physical, occupational, or speech therapies in the Care Plan. In addition, Community Support Services may serve to reinforce skills or lessons taught in other settings.
The cost of transportation related to the provision of Community Support Services is a component of the rate paid for the service.
20.05-6Consultation Services and Assessment- consists of the clinical and therapeutic services that assist unpaid caregivers and/or paid support staff in carrying out Care Plans, and that are not covered by the Medicaid State Plan, and are necessary to improve the member's independence and inclusion in their community. Consultation Services and Assessments are provided by professionals in Psychology, Occupational Therapy, Physical Therapy, Speech Therapy, and Behavioral Health. The service may include assessment, the development of a Care Plan, training and technical assistance to carry out the Care Plan and monitoring of the member and the provider in the implementation of the Care Plan. This service may be delivered in the member's home or in the community as described in the Care Plan. Consultation Services consists of:
(A) Reviews of evaluations and assessments of the member's present and potential level of psychological, physical, and social functioning made through professional assessment techniques; direct interviews with the member and others involved in the Care Plan; review and analysis of previous reports and evaluations, and review of current treatment modalities and the particular applications to the member.(B) Technical assistance to individuals primarily responsible for carrying out the member's Care Plan in the member's home, or in other community sites as appropriate.(C) Assistance in the design and integration of individual development objectives as part of the Care Plan, and training persons providing direct service in carrying out special habilitative strategies identified in the member's Care Plan.(D) Monitoring of the progress of a member in accordance with his or her Care Plan and assisting staff primarily responsible for carrying out the member's Care Plan in the member's home or in other community sites as appropriate, to make necessary adjustments.(E) Providing of information and assistance to the member and other persons responsible for developing the overall Care Plan. Consultation is available in the following specialties: Occupational Therapy, Physical Therapy, Speech Therapy, Behavioral and Psychological services.
Reimbursement for Consultation Services shall be made only to those providers not already reimbursed for consultation as part of another service. Personnel who provide services under Care Coordination may not be reimbursed for Consultation Services.
20.05-7Employment Specialist Services-consists of services necessary to support a member in maintaining employment. Services include: (A) periodic interventions on the job site to identify a member's opportunities for improving productivity, minimizing the need for formal supports by promoting natural workplace relationships, adhering to expected safety practices, and promoting successful employment and workplace inclusion;(B) assistance in transitioning between employers when a member's goal for type of employment is not substantially changed, including assistance identifying appropriate employment opportunities and assisting the member in acclimating to a new job. Employment Specialist Services are provided by an Employment Specialist who may work either independently or under the auspices of a Supported Employment agency. The need for continued Employment Services must be documented in the Care Plan as necessary to maintain employment over time. Employment Specialist Services are provided at work locations where non-disabled individuals are employed as well as in entrepreneurial situations.
The cost of transportation related to the provision of Employment Specialist Services is a component of the rate paid for the service.
A member cannot receive these services while working under a Special Minimum Wage Certificate issued by the Department of Labor under the Fair Labor Standards Act.
20.05-8Home Accessibility Adaptations-consists of those physical adaptations to the private residence of the member or the member's family, required by the member's Care Plan, that are necessary to ensure the health, welfare and safety of the member or that enable the member to function with greater independence in the home. Such adaptations include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or the installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the member. Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the member. Adaptations that add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). Home accessibility adaptations may not be furnished to adapt living arrangements that are owned or leased by providers of waiver services.20.05-9Home Support Services- There are three types of Home Support Services: (A)Home Support Services (Per Diem)-consists of services for a member who requires 24/7 care typically provided in a provider- owned facility with not more than 4 members. The service offers individually tailored supports to assist with the acquisition, retention, or improvement in skills related to living in the community as defined in the Care Plan. The Care Plan will specify the minimum number of 1:1 direct support hours a member needs on a daily basis. These supports include adaptive skill development, assistance with activities of daily living, community inclusion, transportation, adult educational supports, and social and leisure skill development, that assist the member to reside in the most integrated setting appropriate to his/her needs. These supports also include personal care and protective oversight and supervision.(B) Home Support Services (1/4 hour)-consists of services for a member who does not require 24/7 care; the services may be provided in the member's home. The service offers individually tailored supports to assist with the acquisition, retention, or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living, community inclusion, transportation, adult educational supports, social and leisure skill development, that assist the member to reside in the most integrated setting appropriate to his/her needs. These supports also include personal care and protective oversight and supervision.(C) Home Support Services (Remote Support)-consists of services for a member who does not require face-to-face care but would benefit from electronic communication to ensure health and safety. The service is designed to work in concert with Home Support Services (1/4 hour) to provide habilitation support and to assist the member in achieving the most integrated setting possible and increase the member's independence through assistive technology. Whereas members served under this waiver have physical limitations that inhibit their ability to communicate, control their environment, and maintain their personal safety, this service provides real-time remote communication and support through a wide range of technological options including electronic sensors, video conferencing, environmental sensors (movement, door, temperature, smoke, carbon monoxide, etc.), video cameras, microphones and speakers, as well as health monitoring equipment. This assistive technology links each member's residence to the residential service provider. The residential service provider must have staff available 24 hours per day 7 days per weeks to deliver direct 1:1 care when needed. Two levels of emergency back-up are required for any Care Plan that includes Home Support Services (Remote Support). The use of this service is based upon the member's assessed needs and the resulting Care Plan. The Care Plan must reflect the member's and, where applicable, his or her guardian's informed consent and commitment to the Care Plan elements including all assistive communication, environmental control and safety components. A thorough evaluation of all Assistive Technology must be completed prior to the finalization of the Care Plan with the assistance of the Care Coordinator and use of appropriate Assistive Technology consultants. The member must be provided educational support in order to fully understand the risks and benefits of all elements of the Care Plan and this must be documented and acknowledged by the member served. All assistive devices and systems must allow the member served to "opt out." The member must be informed as to the methods for ending a service, either on a short-term basis or permanently. These options must be delineated in the member's Care Plan. If a member served experiences a change in support needs or status, the provider must immediately adjust the direct support services to meet those needs.
All Remote Support Services must be provided in real time. All electronic systems must have back-up power connections to insure functionality in case of loss of electric power. Providers must comply with all federal, state and local regulations that apply to its business including but not limited to the Electronic Communications Privacy Act of 1986.
Any services that use networked services must comply with HIPAA requirements.
Remote Support has two components, Monitor only and Interactive Support. Monitor only means that the member is being electronically monitored for over sight and supervision purposes. Interactive Support means that the member and the staff person monitoring the member electronically are interacting back and forth with the use of cameras.
For all three types of Home Support services:
* Payment is not made under this section for the cost of room and board, including the cost of building maintenance, upkeep and improvement.
* A provider may provide Home Support to more than one member at a time. An individual Personal Care Assistant, Personal Support Specialist, or Direct Support Professional shall not be reimbursed for providing more than a total of 40 hours per week of services delivered to any one individual waiver member.
* The cost of transportation related to the provision of Home Support is a component of the rate paid for the service.
20.05-10Non-emergency Transportation Servicesconsists of services to enable members to gain access to Section 20 services, as specified by the Care Plan. Transportation services for Section 20 services are provided under the MaineCare Benefits Manual, Section 113 Non-emergency Transportation Services. Whenever possible, family, friends or community agencies, which can provide this service without charge, are utilized.20.05-11Non-Traditional Communication Assessments- consists of assessments to determine the member's level of communication present via gesture, sign language or unique individual communication style. The assessment examines signed or gestured vocabulary for everyday objects or actions and the ability to combine gestures as well as the ability to understand similar communication. Assessment recommendations are made to optimize communication to maximize social integration.20.05-12Non-Traditional Communication Consultation- consists of a consultation provided to members, their direct support staff and others to assist the member to maximize communication ability as determined from a Non-Traditional Communication Assessment. The goal is to allow for greater participation in the Care Planning process and to enhance communication within the member's environment. This service is intended to enable members of the team to communicate expressively and receptively with the member during all day-to-day activities, which helps the member to actively participate in his/her Care Plan.20.05-13Occupational Therapy (Maintenance) Services-These services consist of direct therapy and consultation services to maintain the member's optimal level of functioning within the member's current environment. The intent is to prevent regression, loss of movement, injury and medical complications that would result in a higher level of skilled care. Evaluative and rehabilitative therapy is included in the State Plan and is not a covered service.
20.05-14Personal Care Services- consist of a range of assistance to enable waiver members to accomplish tasks that they would normally do for themselves if they did not have a disability. This assistance may take the form of hands-on assistance (actually performing a task for the person) or cuing to prompt the member to perform a task. Personal Care Services may be provided on an episodic or on a continuing basis. Health-related services that are provided may include skilled or nursing care and medication administration to the extent permitted by State law. An individual Personal Care Assistant, Personal Support Specialist or Direct Support Professional shall not be reimbursed for providing more than a total of 40 hours per week of services delivered to any one individual waiver member. Personal Care may be provided outside the member's home. Personal Care is available to members who do not require protective oversight and supervision that is provided in Home Support. In order to avoid duplication, Home Support (Per diem, 1/4 hour or Remote Support), Community Support or Personal Care Services are not available at the same time as other Home Support (Per diem, 1/4 hour or Remote Support) Community Support or Personal Care Services. This service must be delivered in the state of Maine. Services out of state are not covered unless authorized as required by Chapter I of the MaineCare Benefits Manual.
20.05-15Physical Therapy (Maintenance) Services-consist of direct therapy and consultation services to maintain the member's optimal level of functioning within the member's current environment. The intent is to prevent regression, loss of movement, injury and medical complications that would result in a higher level of skilled care. Evaluative and Rehabilitative Therapy is included in the State Plan and is not a covered service under this waiver.
20.05-16Specialized Medical Equipment-Specialized Medical Equipment and supplies consist of: (a) devices, controls, or appliances, specified in the Care Plan, that enable members to increase their ability to perform activities of daily living;(b) devices, controls, or appliances that enable the member to perceive, control, or communicate with the environment in which they live;(c) items necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items;(d) such other durable and non-durable medical equipment not available under the State Plan that is necessary to address member functional limitations; and,(e) necessary medical supplies not available under the State plan. Items reimbursed with waiver funds are in addition to any medical equipment and supplies furnished under the State Plan and exclude those items that are not of direct medical or remedial benefit to the member. All items shall meet applicable standards of manufacture, design and installation. 20.05-17Speech Therapy (Maintenance) Services- Consist of direct therapy and consultation services to maintain the member's optimal level of functioning within the member's current environment. The intent is to prevent regression, loss of movement, injury and medical complications that would result in a higher level of skilled care. Evaluative and Rehabilitative Therapy is included in the State Plan and is not a covered service under this waiver.
20.05-18Work Support Services-consist of intensive, ongoing supports that enable members, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports to perform in a regular work setting, to work in a regular work setting. Work Support Services may include assisting the member to locate a job or developing a job on behalf of the member. Work Support Services are conducted in a variety of settings, particularly work sites where persons without disabilities are employed. Work Support Services includes activities needed to sustain paid work by members, including supervision and training. When Work Support Services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by members receiving waiver services as a result of their disabilities and not for the supervisory activities rendered as a normal part of the business setting. This service is only available in the absence of a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S. C. 1401 et seq.). Members cannot receive these services while working under a Special Minimum Wage Certificate issued by the Department of Labor under the Fair Labor Standards Act.
Documentation must be maintained in the file of each member receiving this service that the service is not available under such a program.
Work Support Services may not be used for incentive payments, subsidies, or unrelated vocational training expenses such as the following:
1. Incentive payments made to an employer to encourage or subsidize the employer's participation in Work Support Services;2. Payments that are passed through to users of Work Support Services; or3. Payments for training that is not directly related to an individual's Work Support Services. Work Support Services must be delivered on an individualized basis and not in a group format. The cost of transportation related to the provision of Work Support Services is a component of the rate paid for the service.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-20, subsec. 144-101-II-20.05