C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-107, subsec. 144-101-II-107.05

Current through 2024-51, December 18, 2024

Subsection 144-101-II-107.05 - COVERED SERVICES

107.05-01Active Treatment: PRTFs must provide active psychiatric treatment, including all the following:

A. Assessment and evaluation, including review of CCON team documents, to be completed in accordance with Section 107.07-07.A.;

B. Medical supervision seven days per week and 24 hours per day;

C. Intensive psychiatric monitoring and intervention, to include medication management and medication administration:

1. Medication Management sessions must occur at least once per week;

D. Behavioral and/or rehabilitative therapies, the specific modality to be described in the member's Treatment Plan. Therapy must include at a minimum, the following:

1. Individual Therapy, at least two (2) hours weekly;

2. Group Therapy, at least one (1) hour daily; and

3. Family Therapy, at least two (2) hours weekly;

E. Comprehensive and individualized discharge planning, to be commenced upon admission to the PRTF and meeting the requirements described in Sections 107.05-04 and 107.07-07 below;

F. Crisis planning and intervention;

G. Development of a Positive Behavioral Support Plan (PBSP) as described in 107.07-08.B;

H. Case management;

I. All transportation services;

J. Personal care, activities of daily living services, and instrumental activities of daily living services, and;

K. Room and board.

107.05-02Development and Periodic Revision of the Treatment Plan as described in Section 107.07-07 of this policy.

107.05-03Ancillary Services: When medically necessary, PRTFs must assure the provision of ancillary services to members enrolled in the PRTF. Ancillary services as described below are billed pursuant to their appropriate section of policy and are as follows:

A.Occupational Therapy Services are covered pursuant to regulations outlined in MaineCare Benefits Manual, Section 68, Occupational Therapy Services and provided by or under the direction of providers who meet the qualifications in accordance with MaineCare Benefits Manual, Section 68, Occupational Therapy Services and acting within his or her scope of practice under Maine State Law.

B.Physical Therapy Services are covered pursuant to regulations outlined in MaineCare Benefits Manual, Section 85, Physical Therapy Services and provided by or under the direction of providers who meet the qualifications in accordance with MaineCare Benefits Manual, Section 85, Physical Therapy Services and acting within his or her scope of practice under Maine State Law.

C.Speech and Hearing Services are covered pursuant to regulations outlined in MaineCare Benefits Manual, Section 109, Speech and Hearing Services and provided by or under the direction of providers who meet the qualifications in accordance MaineCare Benefits Manual, Section 109, Speech and Hearing Services and acting within his or her scope of practice under Maine State Law.

D.Interpreter Services are covered pursuant to regulations outlined in Chapter I, Section 1.06-3 of the MaineCare Benefits Manual.

E.Medical Services: to address any existing or newly diagnosed physical health conditions when medically necessary.

F. Board Certified Behavior Analyst consultation with Prior Authorization.

107.05-04Discharge Planning

A. Discharge planning must be included in the Treatment Plan and be considered a vital component of the member's care.

B. The member and the member's natural supports, including school personnel, and community providers must be considered in the development of the discharge plan. The member's family or guardian must be involved in the development of the discharge plan.

C. As part of the discharge planning requirements, PRTFs must ensure the member has a minimum of a seven-day supply of prescribed medication and a written prescription for medication to last through the first outpatient visit in the community with a prescribing provider.

D. Prior to discharge, the PRTF must identify a prescribing provider in the community and schedule an outpatient visit. Documentation of the medication plan and arrangements for the outpatient visit must be included in the medical record for the member.

E. If medication has been used during the PRTF treatment of the member, but is not needed following discharge, the reason the medication is being discontinued must be documented in the medical record for the member.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-107, subsec. 144-101-II-107.05