Subsection 144-101-II-28.01 - DEFINITIONS28.01-1Authorized Agent shall mean the organization authorized by the Department to perform specified functions pursuant to a signed contract or other approved signed agreement.28.01-2Central Enrollment is a process of determining eligibility for treatment services. The goals of central enrollment are to determine a member's eligibility for treatment; facilitate referrals to appropriate service providers; expedite delivery of service to members in need of treatment; reliably track the service status of members enrolled in the system; and gather data that will inform DHHS of resource development needs.28.01-3Child is a person between the ages of birth through twenty (20) years of age. Children aged eighteen (18) through twenty (20) years of age may choose to receive children's or adult services, whichever best meets their individual needs.28.01-4Comprehensive Assessment is used to identify strengths and needs of the member and family and develop an Individual Treatment Plan. The comprehensive assessment process determines the intensity and frequency of medically necessary services and includes utilization of instruments as may be approved or required by DHHS.28.01-5Crisis Plan/Safety Plan is a plan that must address the safety of the member and others surrounding a member experiencing a crisis.28.01-6Discharge plan is a plan incorporated in the Individualized Treatment Plan that describes the member's planned exit from treatment. The plan must identify discharge criteria, documentation of any after care or support services recommended at the time of discharge, and must be minimally reviewed by the treatment team every ninety (90) days.28.01-7Familymeans the primary caregiver(s) in a member's daily life, and may include a biological or adoptive parent, foster parent, legal guardian or designee, sibling, stepparent, stepbrother or stepsister, brother-in-law, sister-in-law, grandparent, spouse of grandparent of grandchild, a person who provides kinship care, or any person sharing a common residence as part of a single family unit.28.01-8Family Participation may include being a member of the treatment team, participation in the assessment process, and helping to develop the Individual Treatment Plan (ITP). Family participation may also mean participating in treatment, modeling, and reinforcing skills learned in the course of treatment.28.01-9Individual Treatment Plan (ITP) is the plan of care developed by the treatment team and includes the member, if appropriate, the parent or guardian, the provider and natural supports, and is based on a comprehensive assessment and a diagnostic evaluation of the member. The Individual Treatment Plan shall include a Crisis/Safety Plan and a Discharge Plan, along with other elements of the plan of care. The Individual Treatment Plan describes the medically necessary treatment the member will receive.28.01-10Natural Supports include the relatives, friends, neighbors, and community resources that a family goes to for support. They may participate in the treatment team, but are not MaineCare reimbursable.28.01-11Parent or Guardian may be the biological, adoptive, or legal guardian. They must be a participant in the treatment team, but are not MaineCare reimbursable. They must sign the ITP.28.01-12Prior Authorization is the process of obtaining approval prior to the start of the service. All services in this Section require prior authorization, except that for the time period 7/1/2010 through 10/31/2010, prior authorization is not required. The provider will receive a prior authorization letter containing an authorization number and a description of the type, duration and costs of the services authorized. The provider shall retain this letter in the case record for audit purposes. The provider is responsible for providing services in accordance with the prior authorization letter. The prior authorization number is required on the CMS 1500 claim form. All extensions of services beyond the original authorization must be prior authorized by this same procedure.28.01-13School is a program that has been approved by the Department of Education, as either a Special Purpose Private School or a Regular Education Public School Program under 05-071 C.M.R. ch. 101 § XII and 20-A MRSA §7204(4), 7252-A and 7253, and 05-071 C.M.R. ch.101, § 12, or a program operated by the Child Development Services System 20-A MRSA §7001(1-A).28.01-14Specialized Services are medically necessary treatment services that utilize the process of systematically applying interventions based upon empirically derived principles of behavior to improve socially significant behaviors to a measurable degree, and to demonstrate that interventions employed are responsible for improvements in behavior. Assessment includes systematic information gathering regarding factors that influence occurrence of a behavior including interview, direct observation and experimental analysis.28.01-15Treatment Team is the group of people responsible for developing and reviewing a member's ITP. The team may include the member, to the extent possible, and must include the parent/guardian and provider. The member's family, case manager, any other professionals, and those who provide natural supports may also be included.28.01-16Utilization Review is a formal assessment by the Department of the medical necessity, efficacy and appropriateness of services and treatment plans minimally on an annual basis. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-28, subsec. 144-101-II-28.01