Subsection 144-101-II-18.04 - CARE PLAN DEVELOPMENT18.04-1 Procedures for Developing the Care PlanA member's Care Plan will be developed as part of the process of applying to receive services under the waiver. The process for applying is as follows:
A. Choice Letter: The process begins by the member signing and submitting a "choice letter" to the Office of Aging and Disability Services (OADS) requesting services under the waiver. The choice letter is a form that DHHS sends to individuals who may be eligible for services under this section requesting that the individual indicate their preference between receiving services in an institutional setting (such as a nursing facility) or receiving services in a community setting under this section. B. Application: After receiving the choice letter, the DHHS Care Monitor will meet with the member and guardian or power of attorney (where applicable) and complete the initial applicationC. Functional and Medical Assessments: The Care Monitor will request the MED assessment to be completed by the ASA. The Care Monitor will complete the Mayo Portland Adaptability Inventory (or current functional assessment, as approved by the DHHS) and the Department approved Health and Safety Assessment. The Health and Safety Assessment must have been completed within the past 90 days from the date of application. D.Preliminary Care Plan: The Care Monitor will work with the member and guardian or power of attorney (where applicable) to create a preliminary Care Plan to address all safety/risks needs identified by the Health and Safety Assessment, the MED assessment, and the Mayo Portland Adaptability Inventory (or current functional assessment approved by DHHS). Each safety/risk need identified will require a plan to safely support the member in the community with two forms of back-up support. The member will also select the member's service package and preliminary budget. E.Selection of Home Support Option and Development of Final Care Plan: The final Care Plan must be developed by the member, the Care Monitor,guardian or power of attorney (where applicable) and the Home Support Servicesprovider. The member will work with the Care Monitor, guardian or power of attorney (where applicable) to select an approved Home Support provider as outlined in 18. 05-6. Once the Home Support Services provider is selected, the Home Support provider will assist the member in developing the final Care Plan including the budget and selection of services. F.Signatures: In order for the final Care Plan to be approved, the Care Plan must include signatures of (1) the member, or guardian, where applicable, and (2) the Care Coordinator. G. Department Review and Approval: All services must be Prior Authorized by OADS. Prior to implementation or start of Section 18 Services, the Care Plan must be reviewed and approved by OADS, and OADS must determine that the member is eligible for services as outlined in Section 18. 03-1, 2 and 3. H.Utilization Review: All Care Plans must be reviewed and approved by OADS. DHHS and its Authorized Entity reserve the right to conduct Utilization Review of any service authorized under this Section, applying the service-specific eligibility standards set forth in this Section. DHHS and its Authorized Entity may terminate or revise a service authorization upon finding that the member no longer satisfies the eligibility standards for the service or level of service authorized. 18.04-2 Content of the Care PlanAt a minimum the Care Plan must describe:
A. All MaineCare Benefit services determined medically necessary by DHHS;B. The frequency of provision of the services;C. How services contribute to the member's health and well-being and the member's ability to reside safely in a community setting;D. A safety/risk plan, which shall describe the potential risks to the member's health and welfare while living in the community and the reasonable steps to alleviate those risks. Each identified safety need must be addressed by two back-up strategies for meeting the member's safety needs;E. The member's goals for strengthening and cultivating personal, community, family, and professional relationships as identified in the member's most recent Mayo Portland Adaptability Inventory (or current functional assessment, as approved by the DHHS);F. The role and responsibility of the member's providers in supporting the member's goals, including goals for strengthening natural and supportive personal, family, community and professional relationships; andG. A budget for the services to be provided under this section. The Care Plan may include other services not covered under this section that the member may choose to pursue.
18.04-3 Review and Updating of the Care PlanThe Care Plan must be reviewed and updated at a minimum annually, or when there are significant changes in the member's condition sufficient to warrant a review whether the services in place are adequate.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-18, subsec. 144-101-II-18.04