C.M.R. 10, 144, ch. 272, IV

Current through 2024-46, November 13, 2024

Chapter IV - C.C.S./C.S.H.N. PROGRAM TERMINATION

Program coverage may terminate for any of the reasons listed below:

A. Child is no longer resident of Maine;

B. Child reaches the age limitation or termination date established for eligibility for service, Chapter VI, Section X, p. 40-44;

C. Child has achieved maximum alleviation/rehabilitation of the problem or no longer requires sub-specialty treatment;

D. Family's income no longer falls within the C.C.S./C.S.H.N. income eligibility guidelines;

E. Family fails to provide the required annual financial update by the submission deadline;

F. Family voluntarily requests termination of service(s) through the program;

G. If after a 3 month effort, C.C.S./C.S.H.N. program staff have been unable to locate the child/family;

H. There exists no documentation or recommendation of a current need for service;

I. C.C.S./C.S.H.N. program rule change eliminates child's current eligibility or current scope of services provided. Anyone made ineligible by future rule changes is notified in writing of the proposed rule change and is given the opportunity to comment on the rule change through the Maine Administrative Procedures Act process;

J. Child's medical condition no longer meets C.C.S./C.S.H.N. Program specific policy as outlined in Chapter VI, Conditions and Components of Care and/or Chapter III, Item C;

K. Child no longer qualifies for therapy services as outlined in Chapter VI, Section X, p. 41-44; or

a. all long term therapy goals are met

b. progress report indicates child is maintaining same level of function or less for the past six months

c progress is not possible due to the need for further medical/surgical intervention (however, authorization may be reinstated after the occurrence of these procedures)

d C.S.H.N. is in receipt of notification from the therapist that therapy has terminated

e child reaches age of kindergarten/school entry

L. Child loses SSI and does not otherwise qualify for services through C.C.S./C.S.H.N.;

M. Death of the child; or

N. Lack of funds (Chapter V, Section G, Priority for Program Expenditures).

C.M.R. 10, 144, ch. 272, IV