18.05-1 Assistive Technology Device and Services- Assistive Technology Device means an item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of members. Assistive Technology Service means a service that directly assists a member in the selection, acquisition, or use of an Assistive Technology device. Assistive Technology Services include:
A. the evaluation of the Assistive Technology needs of a member, including a functional evaluation of the impact of the provision of appropriate Assistive Technology Devices and appropriate Assistive Technology Services to the member in the customary environment of the member;B.) services consisting of purchasing, leasing, or otherwise providing for the acquisition of Assistive Technology Devices for members;C. services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing Assistive Technology Devices;D. coordination and use of necessary therapies, interventions, or services with Assistive Technology Devices, such as therapies, interventions, or services associated with other services in the Care Plan;E. training or technical assistance for the member, or, where appropriate, the family members, guardians, advocates, or authorized representatives of the member; F. training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of members; andG. transmission of data required for use of the Assistive Technology Device via internet or cable utility. Assistive Technology Services excludes duplicate services available under the State Plan subject to § 18. 06-7. The components above are subject to the following limits:
* The Assistive Technology Device and services described above in paragraphs (B) and (C) are subject to a combined limit of $6,000. 00 annually.
* The services described above in paragraphs (A), (D), (E) and (F) are subject to a combined limit of 32 units (8 hours) annually.
* The data transmission utility costs described above in paragraph (G) are limited to $50. 00 per month.
18.05-2 Care Coordination Service- consists of a conflict-free service that assist members in gaining access to needed waiver and State Plan services, as well as medical, social, educational and other services, regardless of the funding source for the services to which access is sought. Care Coordination Services also include responsibility for assisting the member to access and coordinate natural supports, and monitoring and assurance of the implementation of the Care Plan. This includes monitoring of the health, welfare and safety of the member. This service requires face-to-face contact between the Care Coordinator and the member, at a minimum, every thirty days. A member who has this service may not receive duplicative care coordination services including, but not limited to, Section 13, "Targeted Case Management Services"; Section 91, "Health Home Services"; Section 92, "Behavioral Health Home Services"; or similar such services under the State Plan. 18.05-3 Career Planning-Career planning is a person-centered, comprehensive employment planning and direct support service that provides assistance for a waiver program participant to obtain, maintain or advance in competitive employment or self-employment at or above the State's minimum wage. It is a focused, time limited service engaging a participant in identifying a career direction and developing a plan for achieving competitive, integrated employment at or above the State's minimum wage. The outcome of this service is documentation of the participant's stated career objective and a career plan used to guide individual employment support. This service assists in identifying skills, priorities, and capabilities determined through an individualized discovery process. This may include a referral to benefits planning, referral of assessment for use of assistive technology to increase independence in the workplace, development of experiential learning opportunities and career options consistent with the participant's skills and interests. Career Planning may be used in preparation to gather information to be used as part of a referral to Vocational Rehabilitation. Career planning furnished under the waiver may not include services available under a program funded under section 110 of the Rehabilitation Act of 1973 or section 602(16) and (17) of the Individuals with Disabilities Education Act (20 U. S. C. § 1401 (16 and 17).
Career Planning is limited to 60 hours annually, to be delivered in a six-month period. No two six-month periods may be provided consecutively. Career Planning services must have the long-term goal of individual, competitive, integrated employment for which the member is compensated at or above the minimum wage. In order to receive Career Planning services, the member's Care Plan must identify specific career goals and describe how the Career Planning services will be used to achieve those goals.
Career Planning services can be provided within a variety of community settings such as a Career Center, the community and local business and must be documented in the Care Plan with related goals.
18.05-4 Community/Work Reintegrationis an integrated clinical service to improve the member's ability to successfully integrate into his or her current or desired community and/or work setting. The service includes compensatory interventions and treatment focused on functional improvement and reinforcement of community and work reintegration for the member. Specifically, the treatment is based on the clinical needs of the member as defined by their current Mayo Portland Adaptability Inventory. Individual functional goals are defined based on these identified needs. These treatments are provided on a 1:1 and group basis. Group services are coded with HQ and may be provided in groups up to 6 participants. 18.05-5 Employment Specialist Services- consists of services necessary to support a member in maintaining employment. Services include: A. periodic interventions on the job site to identify a member's opportunities for improving productivity, minimizing the need for formal supports by promoting natural workplace relationships, adhering to expected safety practices, and promoting successful employment and workplace inclusion; B. assistance in transitioning between employers when a member's goal for type of employment is not substantially changed, including assistance identifying appropriate employment opportunities and assisting the member in acclimating to a new job. The need for continued Employment Services must be documented in the Care Plan as necessary to maintain employment over time; andC. For Job Development, if Vocational Rehabilitation denies services under the Rehabilitation Act and the member is unable to benefit from Vocational Rehabilitation then the member may receive Employment Specialist Services for job development. If Employment Specialist Services are used for job development, current documentation of ineligibility from Vocational Rehabilitation is required. Employment Specialist Services are provided by an Employment Specialist who may work either independently or under the auspices of a Supported Employment agency.
Employment Specialist Services are provided at work locations where non-disabled individuals are employed as well as in entrepreneurial situations. Employment Specialist Services may be utilized to assist a member to establish and or sustain a business venture that is income-producing. MaineCare funds may not be used to defray the expenses associated with the start-up or operating a business.
A member may not receive Employment Specialist Services while enrolled in high school.
The cost of transportation related to the provision of Employment Specialist Services is a component of the rate paid for the service and is not separately billable.
A member cannot receive these services while working under a Special Minimum Wage Certificate issued by the Department of Labor under the Fair Labor Standards Act.
Employment Specialist Services cannot be provided at the same time as Work Support Services.
18.05-6 Home Support Services- There are four types of Home Support Services: A. Home Support Services(1/4 hour) Level I- consist of services for a member who does not require 24/7 care; the services may be provided in the member's home. The service offers individually tailored supports to assist with the acquisition, retention, or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living, community inclusion, transportation, adult educational supports, social and leisure skill development, that assist the member to reside in the most integrated setting appropriate to his/her needs. These supports also include personal care and protective oversight and supervision.
B. Home Support Services (Per Diem) Level II-consist of services for a member who requires 24/7 care typically provided in a provider- owned facility with not more than 8 members. The service offers individually tailored supports to assist with the acquisition, retention, or improvement in skills related to living in the community as defined in the Care Plan. The Care Plan will specify the minimum number of 1:1 direct support hours a member needs on a daily basis. These supports include adaptive skill development, assistance with activities of daily living, community inclusion, transportation, adult educational supports, and social and leisure skill development, that assist the member to reside in the most integrated setting appropriate to his/her needs. These supports also include personal care and protective oversight and supervision.
C. Home Support Services (Per Diem) Level III- Home Support (Residential Habilitation)Level III- Increased Neurobehavioral- consist of services for a member who requires 24/7 care typically provided in a provider-owned facility with not more than 8 members. This service is for members who have an increased clinical need relating to their behaviors associated with their brain injury. To qualify for Home Support Services Level III, a member must have at least a score of 0. 5 on the Department Approved Health and Safety Assessment. The service is intended for members who are not typically successful without structured services in an individually tailored setting, and who typically are not successful in group settings. The service includes neurobehavioral treatment specific to the individual's needs, as well as personal care and protective oversight and supervision. The Care Plan will specify the minimum number of 1:1 direct support hours a member needs on a daily basis. The service offers individually tailored supports to assist with the acquisition, retention, or improvement in skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living, community inclusion, transportation, adult educational supports, social and leisure skill development, that assist the member to reside in the most integrated setting appropriate to his/her needs. Home Support (Residential Habilitation) Level III is an intensive neurobehavioral level of treatment. The rate for this service is all inclusive and therefore, includes the treatment of cognitive and behavioral clinical needs for the Member as part of the rate. A member who has this service may not receive Self/Home Reintegration, Work/Community Reintegration, or Work Ordered Day Club House as separate services.
D. Home Support Services (Remote Support) - consist of services for a member who does not require face-to-face care but would benefit from electronic communication to ensure health and safety. The service is designed to work in concert with Home Support Services (1/4 hour) to provide habilitation support and to assist the member in achieving the most integrated setting possible and increase the member's independence through assistive technology. Whereas members served under this waiver have limitations that inhibit their ability to communicate, control their environment, and maintain their personal safety, this service provides real- time remote communication and support through a wide range of technological options including electronic sensors, video conferencing, environmental sensors (movement, door, temperature, smoke, carbon monoxide, etc.), video cameras, microphones and speakers, as well as healthmonitoring equipment. This assistive technology links each member's residence to the residential service provider. The residential service provider must have staff available 24 hours per day 7 days per weeks to deliver direct 1:1 care when needed. Two levels of emergency back-up are required for any Care Plan that includes Home Support Services (Remote Support). The use of this service is based upon the member's assessed needs and the resulting Care Plan. The Care Plan must reflect the member's and, where applicable, his or her guardian's informed consent and commitment to the Care Plan elements including all assistive communication, environmental control and safety components. A thorough evaluation of all Assistive Technology must be completed prior to the finalization of the Care Plan with the assistance of the Care Coordinator and use of appropriate Assistive Technology consultants. The member must be provided educational support in order to fully understand the risks and benefits of all elements of the Care Plan and this must be documented and acknowledged by the member served. All assistive devices and systems must allow the member served to "opt out. " The member must be informed as to the methods for ending a service, either on a short-term basis or permanently. These options must be delineated in the member's Care Plan. If a member served experiences a change in support needs or status, the provider must immediately adjust the direct support services to meet those needs.
All Remote Support Services must be provided in real time. All electronic systems must have back-up power connections to insure functionality in case of loss of electric power. Providers must comply with all federal, state and local regulations that apply to its business including but not limited to the "Electronic Communications Privacy Act of 1986".
Any services that use networked services must comply with HIPAA requirements.
Remote Support has two components, Monitor only and Interactive Support. Monitor only means that the member is being electronically monitored for over sight and supervision purposes. Interactive Support means that the member and the staff person monitoring the member electronically are interacting back and forth with the use of cameras or other approved devices.
Payment is not made under this section for the cost of room and board, including the cost of building maintenance, upkeep and improvement.
A provider may provide Home Support to more than one member at a time.
The cost of transportation related to the provision of Home Support is a component of the rate paid for the service and is not separately billable.
18.05-7 Non-Medical Transportation Services consists of services to enable members to gain access to certain Section 18 Covered Services, as specified by the Care Plan. Transportation services for Section 18 services are provided under the MaineCare Benefits Manual, Section 113,"Non-Emergency Transportation Services". Whenever possible, family, friends or community agencies, which can provide this service without charge, must be utilized. A provider may only be reimbursed for providing transportation when the cost of transportation is not a component of a rate paid for another service.
18.05-8 Self Care/Home Management Reintegration is an integrated clinical service to improve the member's ability to care for him/herself successfully and/or manage his/her home setting successfully. The service that includes compensatory interventions and treatment focused on functional improvement and reinforcement of self-care and home management reintegration for the member. Specifically, the treatment is based on the clinical needs of the member as defined by their current Mayo Portland Adaptability Inventory. Individual functional goals are defined based on these identified needs. Group services are coded with HQ and may be provided in groups of up to 6 participants. 18.05-9 Work Ordered Day Club House is a set of services provided at a community-based facility, referred to as a "Club House," that assist members with community reentry, the rebuilding of social relationships and the training of skills required to return to productive activity. The Work Ordered Day Club House is designed to help individuals build skills specific to a work environment. This Service specializes in treatment techniques for members with acquired brain injuries. Providers of Services develop and provide staff training, which focuses on the needs of individuals with an acquired brain injury identified in the Care Plan, and the specific manner in which this service will meet the member's individual needs. The program focuses on adaptive skills and is distinct from work production objectives. These services are provided during the day through programs that are offered at facilities within the community. At the end of each day, the member returns to his/her home.
18.05-10 Work Support Services-consist of intensive, ongoing supports that enable members, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports to perform in a regular work setting, to work in a regular work setting. Work Support Services may include assisting the member to locate a job or developing a job on behalf of the member. Work Support Services are conducted in a variety of settings, particularly work sites where persons without disabilities are employed. Work Support Services includes activities needed to sustain paid work by members, including supervision and training. When Work Support Services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptations, supervision and training required by members receiving waiver services as a result of their disabilities and not for the supervisory activities rendered as a normal part of the business setting. This service is only available in the absence of a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U. S. C. §§1401 et seq.). Members cannot receive these services while working under a Special Minimum Wage Certificate issued by the Department of Labor under the Fair Labor Standards Act.
Documentation must be maintained in the file of each member receiving this service that the service is not available under such a program.
Work Support Services may not be used for incentive payments, subsidies, or unrelated vocational training expenses such as the following:
A. Incentive payments made to an employer to encourage or subsidize the employer's participation in Work Support Services; orB. Payments that are passed through to users of Work Support Services; or C. Payments for training that is not directly related to an individual's Work Support Services. Work Support Services must be delivered on an individualized basis and not in a group format.
The cost of transportation related to the provision of Work Support Services is a component of the rate paid for the serviceand is not separately billable.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-18, subsec. 144-101-II-18.05