Subsection 144-101-II-28.02 - ELIGIBILITY FOR SERVICETo be found eligible for Rehabilitative and Community Support Services For Children With Cognitive Impairments and Functional Limitations, a member must be under twenty-one years of age and meet all of the following criteria:
A. Individuals must meet the financial eligibility criteria as set forth in the MaineCare Eligibility Manual (MEM).B. All services must be medically necessary pursuant to Chapter I, Section 1.02-4.D. of the MaineCare Benefits Manual and identified in the ITP.C.Specific Eligibility Criteria1. The member must have a completed multi-axial evaluation with an Axis I or Axis II behavioral health diagnosis using the most recent Diagnostic and Statistical Manual of Mental Health Disorder or an Axis I diagnosis from the most recent Diagnostic Classification of Mental Health or Developmental Disorders of Infancy and Early Childhood Manual (DC-03); ANDa. Have a functional assessment administered within one (1)year prior to the date of the referral documenting functional impairment measured as two (2) standard deviations below the mean on the composite score or have one point five (1.5) standard deviations below the mean on the composite score and two standard deviations below the mean in the communication or social domain sub score of the most current version of the Vineland Adaptive Behavior http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=Vineland-II, or the Adaptive Behavioral Assessment Scales http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8004-507&Mode=summary, orb. have a functional assessment administered within one (1) year prior to the date of the referral documenting functional impairment measured as two (2) standard deviations below the mean on the Developmental Quotient of the Battelle Developmental Inventory or have 1.5 standard deviations below the mean on the Developmental Quotient and two (2) standard deviations below the mean on in the Personal-Social, Adaptive, Communication, or Cognitive subscales.http://www.riverpub.com/products/bdi2/index.html, orc. have a functional assessment administered within one (1) year prior to the date of the referral documenting functional impairment measured as two (2) standard deviations below the mean on the composite Adaptive Score of the Bayley Scales of Infant and Toddler Development or have 1.5 standard deviations below the mean on the composite Adaptive Score and two (2) standard deviations below the mean on the Social or Communication domain or Cognitive, Language or Social Emotional Subscale. http://www.pearsonassessments.com/haiweb/cultures/en-us/productdetail.htm?pid=015-8027-264 ord. other functionally equivalent tools approved by DHHS and other clinical assessment information obtained from the member and family; or2. A member aged birth through five (5) years, who has a diagnosis from a physician (including psychiatrist) of a specific congenital or acquired condition, and a written assessment by a physician (including psychiatrist) that there is a significant probability that because of that condition, the member will meet the functional impairment criteria in (C)(1) above, later in life if medically necessary services and supports are not provided to the member;3. Family Participation is required in treatment services to the greatest degree possible given the individual needs as well as family circumstances. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-28, subsec. 144-101-II-28.02