C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-21, subsec. 144-101-II-21.04
The Person-Centered Service Plan (PCSP), and the planning for the PCSP, must comply with the requirements of the Global HCBS Waiver Person-Centered Planning and Settings Rule ("Global HCBS Rule"), MaineCare Benefits Manual, Chapter 1, Section 6.
If the Member or guardian chooses services under this Section, the request for services must be submitted to DHHS or its Authorized Entity. As part of the planning process, the Member's needs are identified and documented in the Person-Centered Service Plan.
Except for residential services, other services shall be provided to the Member within ninety (90) days of the completed execution of a service agreement or amended service agreement. For residential services, if the service agreement or amended service agreement identifies a need, such services shall be provided within eighteen (18) months of the execution of the agreement. The time periods set forth in this section are subject to the funded opening and waiting list provisions in sections 21.01 and 21.03.
Services and units of services must be identified in the Person-Centered Service Plan. Requests for all Section 21 services must be submitted to DHHS or its Authorized Entity for Prior Authorization in order for the services to be reimbursed.
All Prior Authorizations are time-limited, and the length of the authorization may vary by Member and service as documented in the Person-Centered Service Plan. Upon expiration of an authorization, a new authorization must be obtained before reimbursement may be provided for the service.
DHHS and its Authorized Entity reserve the right to conduct Utilization Review of any service authorized under this Section, applying the service-specific eligibility standards set forth in this Section. DHHS and its Authorized Entity may terminate or revise a service authorization upon finding that the Member no longer satisfies the eligibility standards for the service or level of service authorized.
In addition to the Global HCBS Rule provisions concerning Person-Centered Planning, the following requirements must be met.
Case Managers shall meet with the Member prior to each planning meeting to ensure conflict-free planning and informed choice. The planning process must reflect the Member's cultural preferences and provide information in plain language that is accessible to the Member and, when applicable, his or her legal representative. In addition to the above, and according to Title 34-B § 5466, Members are entitled to have access to an advocate. Providers must ensure Members are aware of this entitlement prior to the planning meeting to allow for inclusion of an advocate if the Member so chooses.
Pursuant to the Global HCBS Rule, the Person-Centered Service Plan must reflect the services and supports that are important for the Member to meet the needs identified through an assessment of functional need, as well as what is important to the Member with regard to preferences for the delivery of services and supports. The effective plan date must be less than six (6) months old at the time of the Member's eligibility determination or redetermination. The planning process must comply with the requirements described in the Global HCBS Rule.
The PCSP must include the following:
The PCSP will be used by DHHS to identify the type and units of authorized services the Member may receive under this Section. If more than one provider is reimbursed for the same category of direct support activities, an explanation of the differences in roles and responsibilities of each provider and how services will not be duplicated is required.
All providers must ensure that notice of the grievance process outlined in 14-197 CMR ch. 8 (Rule Describing Grievance Process for Persons with Intellectual Disabilities and Autism) is regularly provided to Members served by the provider. Providing notice includes, at a minimum, ensuring that written notice of the grievance process is provided to the Member and their guardian at any planning meeting; posting notice of the grievance process in an appropriate common area of all facilities operated by the provider; and posting notice of the grievance process on any website maintained by the provider. In addition, the provider must ensure that all staff are trained in the grievance process. Staff must receive training in the grievance process upon hire, prior to working with Members and then every thirty-six (36) months thereafter.
Each Member or guardian will determine the composition of the Planning Team. The Member will lead and direct the Person-Centered Service Planning Process whenever possible, including leading the planning meeting if he/she desires. The Member's guardian should have a participatory role, as defined by the Member, unless state law confers decision-making authority to the legal guardian.
The Case Manager will ensure that the plan meeting is scheduled. The Case Manager or Case Management Supervisor will support the Member or legal guardian to schedule the meeting at times and locations of convenience to the Member and to include individuals of the Member's choosing.
In addition to the Member, the planning team may include the following members, or when invited by the Member:
The Member's Person-Centered Service Plan must be reviewed, revised and updated at least annually, based on the plan's effective date or at the request of the Member or guardian; or when other significant changes occur relating to the Member's physical, social, behavioral, medical, communication, or psychological needs; or when the Member has made significant progress toward his or her goals. The Case Manager must reconvene the Planning Team to revise and update the Person-Centered Service Plan as service needs change including the location where services are received. Planning meetings must be held both prior to and thirty (30) days subsequent to the planned move of a Member to a new service in order to coordinate and to evaluate the Member's satisfaction with the change.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-21, subsec. 144-101-II-21.04