Subsection 144-101-II-17.08 - POLICIES AND PROCEDURES17.08-1Assessments. The following policies and procedures apply to covered services related to the assessment of a member, as described in Section 17.08-1(B):A. If the member seeking Community Support Services is in a crisis/outreach situation, it may not be necessary or possible for the assessment to cover all of the areas generally covered in an assessment. An exception to the scope of the assessment may be made by a supervisory mental health professional and recorded in the member's record. A complete Community Support Services assessment must be developed as soon as clinically feasible, but no later than thirty (30) days.B. The clinical components of an assessment will be: 1. Performed by the appropriate mental health professionals acting within the scope of their license;2. Coordinated by a Community Support Provider.C. The member or guardian seeking Community Support Services will be an integral part of the assessment and will provide essential information. The member's family or significant other also may be involved, unless such involvement is not feasible or contrary to the wishes of the member or guardian.D. A Community Support Provider shall develop a comprehensive ISP as defined in 17.04-1(E) within thirty (30) days of application of a member for covered services 17.04-1 (Community Integration), 17.04-2 (Community Rehabilitation Services),17.04-3 (Assertive Community Treatment-ACT). For all other Section 17 Covered Services, an ISP as specified in 17.01-12 must be developed within thirty (30) days of acceptance. These timeframes must be met unless there is documentation in the member's file that supports a clinical reason why the assessment was not done within thirty (30) days. In these cases, the assessment and the ISP or treatment plan must be developed as soon as clinically feasible.E. Assessments must indicate the member's diagnosis and the name and credentials of the clinician who determined the diagnosis.17.08-2Individual Support Plan (ISP). The following apply to covered services related to a member's individual support plan described in 17.04-1.C and 17.01-11: A. The ISP must be based on the results of the assessment;B. All identified clinical services indicated in the ISP must be approved by a Mental Health Professional;C. To help the member achieve the objectives of his or her ISP, the Community Support Provider shall provide information and support to the member or guardian and, unless not feasible or contrary to the wishes of the member or guardian, to his or her family or significant other;D. To ensure that the member has access to specific services, supports, and resources identified in his or her ISP, the Community Support Provider shall provide coordination and advocacy and by working directly with providers, advocates, and informal support systems;E. To ensure that the ISP is being followed and is appropriate to a member's needs, the Community Support Provider shall:1. Review ISP to determine efficacy of the services and natural supports and to formulate changes in the plan as necessary; and2. Evaluate the effectiveness of the ISP with the member or guardian and, unless not feasible or contrary to the wishes of the member or guardian, with other providers and the member's family or significant other; andF. The ISP as defined in 17.04-1(E) must be reviewed and approved in writing by a mental health professional within the first thirty (30) calendar days of application of the member for those services and every ninety (90) calendar days thereafter, or more frequently as indicated in the ISP. An ISP related to 17.04-4 (Daily Living Support Services), 17.04-5 (Skills Development Services), 17.04-6 (Day Support Services) must be reviewed and approved in writing by a Mental Health Professional within the first thirty (30) days of acceptance.17.08-3Records. The Community Support Provider shall maintain an individual record for each member receiving covered services. The record must minimally include: A. Name, birthdate, and MaineCare identification number;B. Pertinent available medical information regarding the member's condition;C. The member's written ISP;D. Documentation of each service provided, including the date of service, the type of service, the goal to which the service relates, the duration of the service, the progress the member has made towards goal attainment and the signature and credentials of the individual performing the service.17.08-4Member Appeals. Any decision made by DHHS or its Authorized Entity to terminate, reduce, or suspend MaineCare services will be provided to the member in writing with notice of hearing rights as described in Chapter I of the MaineCare Benefits Manual.17.08-5Protections for Adults with Serious and Persistent Mental IllnessIf the member is an Adult with a Serious and Persistent Mental Illness (i.e., the member meets the eligibility criteria in 17.02-3) and is receiving Community Integration Services or Assertive Community Treatment (ACT) Services reimbursed under Section 17,as identified in the member's Individual Support Plan, then the provider must:
A. Obtain written approval from the Director of the Office of Behavioral Health (OBH) or designee prior to terminating services to that member; 1. Written approval is not required in cases where the terminating provider has successfully facilitated a member's transfer, with the member's consent, to a new provider;B. If approved by OBH, issue a thirty (30) calendar day advanced written termination notice to the member prior to termination of the member's services. In cases where the member poses a threat of imminent harm to persons employed or served by the provider, the Director of the Office of Behavioral Health(or designee) may approve a shorter notification for termination of services;C. Assist the member in obtaining clinically necessary services from another provider prior to discharge or termination; and D. Accept referrals through the Department-defined referral process within seven (7) calendar days. Only in cases where providers have received written approval of declination from OBH may a referral be declined. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-17, subsec. 144-101-II-17.08