Subsection 144-101-II-20.02 - DEFINITIONS20.02-1Abuse means the infliction of injury, unreasonable confinement, intimidation or cruel punishment that causes or is likely to cause physical harm or pain or mental anguish; sexual abuse or sexual exploitation; or the intentional, knowing or reckless deprivation of essential needs as defined in 22 M.R.S. §3472.20.02-2Assessing Services Agency (ASA) is an Authorized Entity of the Department of Health and Human Services (DHHS) for Medical Eligibility Determinations that conducts face-to-face assessments, using DHHS Medical Eligibility Determination form or other DHHS approved form.20.02-3Authorized Entity is the organization authorized by the Department of Health and Human Services (DHHS) to perform specified functions pursuant to a signed contract or other approved signed agreement.20.02-4BMS 99is the assessment tool used to determine functional limitations of the member.20.02-5Care Coordinator is a provider organization staff person who is responsible for the development and ongoing support of the implementation of the Care Plan. This includes monitoring of the health, welfare and safety of the participant.20.02-6Care Monitor is the Department of Health and Human Services (DHHS) professional who assists the member with the member's enrollment in the waiver services and monitors the services received to assure they are meeting the health and safety needs of the member.20.02-7Care Plan is a comprehensive document that specifies the services a member will receive under this section and the manner in which those services will be provided.20.02-8Exploitation means the illegal or improper use of an incapacitated or dependent member or that member's resources for another's profit or advantage as defined in 22 M.R.S. §3472.20.02-9Habilitation is a service that is provided in order to assist a member to acquire a variety of skills, including self-help, socialization and adaptive skills. Habilitation is aimed at raising or retaining the level of physical, mental, and social functioning of a member. Habilitation is contrasted to rehabilitation which involves the restoration of function that a person has lost.20.02-10Intellectual Disability means a diagnosis of Mental Retardation as defined in Section 317-319 in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association), that manifested during the developmental period, in accordance with the definition of Intellectual Disability codified in 34-B M.R.S. §5001. The terms "mental retardation" and "intellectual disability" are used interchangeably in these regulations.20.02-11Medical Eligibility Determination (MED) Tool means the form approved by DHHS to assess the medical service needs of the member. The information provided by the MED tool will be used in determining the eligibility for the waiver and authorizing services.20.02-12Member is a person determined to be eligible for MaineCare benefits by the Office for Family Independence (OFI) in accordance with the eligibility standards published by the OFI in the MaineCare Eligibility Manual. Some members may have restrictions on the type and amount of services they are eligible to receive.20.02-13Money Follows the Person-Homeward Bound Transition Coordinator is the person who is chosen by the member to provide transition Assistance from the agencies contracted by the Department for the Money Follows the Person-Homeward Bound program.20.02-14Natural Supports include the relatives, friends, neighbors, and community resources that a member or family goes to for support. They may participate in the treatment team, but are not MaineCare reimbursable.20.02-15Neglect means a threat to an member's health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these as defined in 22 M.R.S. §3472.20.02-16Prior Authorization (PA) is the process of obtaining prior approval as to the medical necessity and eligibility for a service.20.02-17Utilization Review is a formal assessment of the medical necessity, efficiency and appropriateness of services and Care Plans on a prospective, concurrent or retrospective basis. The provider is required to notify DHHS or its Authorized Entity upon initiation of all services provided under Section 20 in order for the Authorized Entity to begin utilization review. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-20, subsec. 144-101-II-20.02