C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-29, subsec. 144-101-II-29.05
If authorized, the Department expects that Home Support-Remote Support Hours will be implemented within 90 days of assessment.
Assistive Technology includes;
Assistive Technology-Assessment is subject to a combined limit per year. See Section 29.07 below.
Assistive Technology-Devices is subject to a combined limit per year. See Section 29.07 below.
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. In order to receive Career Planning services, the member's Personal Plan must identify the need to explore work, identify career direction and describe how the Career Planning services will be used to achieve those goals.
The service requires submission of the Career Plan at 3 intervals to DHHS in order to ensure that the service is provided in a manner that will result in competitive, integrated employment or self-employment at or above the current minimum wage.
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 Personal Plan with related goals.
The cost of Transportation related to the provision of Career Planning is a component of the rate paid for the service.
Community Support is intended to be flexible, responsive and provided to members as defined by the member's choice and needs as documented in the member's personal plan. The location of the service and staffing level may vary, allowing for a mix of individualized and group services.
Community Support allows for opportunities for career exploration and the facilitation of discussions about the benefits of working. Activities and discussions related to work should be relevant to identifying a member's employment interests, their individual strengths as related to employment, employment goals and the conditions necessary for the member to achieve and maintain successful employment.
The average staff to member ratio for Community Support for each program location must not exceed 1:3.
Nothing in this rule prohibits one-to-one (1:1) service delivery.
"On Behalf of" is a component of Community Support; and is included in the established authorization and is not a separate billable service.
A member may not receive Community Support while enrolled in high school. A member may not receive Community Support at his or her place of employment.
The cost of transportation related to the provision of Community Support is a component of the rate paid for the service and is not separately billable. For specific limits of this service see 29.07.
Within the scope of Community Support, there may be activities that require that the service be provided in the member's home; this will involve the origination or termination of the Community Support Service. This is allowable as long as it does not duplicate Home Support.
Employment Specialist Services are provided by an Employment Specialist who may work either independently or under the auspices of a Supported Employment provider but must have completed the approved Employment Specialist training as outlined by DHHS in order to provide Employment Specialist Services. The need for continued Employment Services must be documented in a member's Personal Plan as necessary to maintain employment over time.
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.
"On Behalf of" will continue as a component of Employment Specialist Service; and is included in the established authorization and is not a separate billable service.
The cost of transportation related to the provision of Employment Specialist Services is a component of the rate paid for the service.
Employment Specialist Services are provided on an intermittent basis with a maximum of 10 (ten) hours each month.
Nothing in this rule prohibits a member from 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-Group or Work Support-Individual.
Adaptations must not be covered under state plan services, including Section 60, Medical Supplies and Durable Medical Equipment of the MaineCare Benefits Manual and must be determined medically necessary as documented by a licensed physician and approved by DHHS Office of Aging and Disability Services (OADS). Adaptations commonly include:
Bathroom modifications Widening of doorways Light, motion, voice and electronically activated devices Fire safety adaptations Air filtration devices Ramps and grab-bars Lifts (can include Barrier-free track lifts) Specialized electric and plumbing systems for medical equipment and supplies Lexan windows (non-breakable for health & safety purposes) Specialized flooring (to improve mobility and sanitation)Items not included above but which have been recommended in a Personal Plan are subject to approval by the DHHS for reimbursement.
Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the member. Adaptations that add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation (e.g. in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). In-floor radiant heating is not allowable. General household repairs are not included in this service. All services shall be provided in accordance with applicable State or local building codes. All providers must be appropriately licensed or certified in order to perform this service. This service applies to member owned or a member's family owned home only. Provision of this service in a property owned, rented or leased by an agency is acceptable as long as the adaptation is portable and is the property of the member.
The limit for adaptations is ten thousand dollars ($10,000) in a five (5) year period, with an additional annual allowance up to three hundred dollars ($300) for repairs and replacement per year. All items in excess of five hundred dollars ($500) require documentation from a physician or other appropriate professionals such as OT, PT or Speech therapists that the purchase is appropriate and medically necessary to meet the member's need. Medically necessary home modifications that cannot be obtained as a covered service under any other MaineCare benefit may be reimbursed under this section if they meet all requirements of this Section.
Within the scope of Home Support, there may be activities that require that the service be carried over into the community. Nothing in this rule is intended to prohibit community inclusion as a reimbursable service accompanied by documentation on the Personal Plan provided that the service has a therapeutic outcome. An example is shopping for food, which may later be prepared in the home. This is allowable as long as it does not duplicate Community Support.
Home Support cannot be provided at a Member's employment site.
On Behalf Of is a component of Home Support and is included in the established authorization and is not a separate billable activity. 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.
There is no overlap between Assistive Technology and Home Support Remote Support. Assistive Technology provides for the assessment, the equipment and the cost of the monthly transmission. Home Support-Remote Support provides the staff who are monitoring the member.
The Remote Support provider has staff available 24 hours per day 7 days per week to deliver direct 1:1 care when needed. If a member chooses this service, the member's Personal Plan must include a safety/risk plan that identifies at least two levels of emergency back-up.
The use of this service is based upon the member's assessed needs and the resulting Personal Plan. The Personal Plan reflects the member's consent and commitment to the plan elements including all assistive communication, environmental control and safety components. An Assistive Technology Assessment must be completed by a qualified consultant prior to the finalization of the Personal Plan by the case manager and the member with the assistance of the Planning Team to ensure the appropriateness of assistive technology.
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 "ElectronicCommunications Privacy Act of 1986". Any services that use networked services must comply with HIPAA requirements.
There is no overlap between Assistive Technology and Home Support Remote Support. As set forth in §29.05-1, Assistive Technology may be used to provide for assessments, equipment, and the cost of the monthly data transmission utility necessary to facilitate Home Support-Remote Support services. Home Support-Remote Support provides the staff monitor the member.
There are two types of Remote Support: Interactive Support and Monitor Only. Chapter III reflects the billing for each type. Interactive Support includes only the time that staff is actively engaging a member in 1 to 1 direct support through the use of the Assistive Technology Device. Monitor Only is when Assistive Technology equipment is being used to monitor the member without interacting.
For this Service, respite is a component of the rate paid to the Administrative Oversight Agency and therefore is not a separate billable service. The record must accurately reflect the member's location during the receipt of respite.
Only one member may receive services in any one Shared Living arrangement at the same time, unless a relationship existed prior to the service arrangement and the arrangement has been approved by DHHS. In such case, no more than two members may be served in any one Shared Living arrangement concurrently.
Whenever possible, family, neighbors, friends, or community agencies, which can provide this service without charge, are utilized.
A provider may only be reimbursed for providing transportation services when the cost of transportation is not a component of a rate paid for another service.
To receive this service, a member must have received an assessment and services under the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act and need for on-going support must have been determined and documented in the Personal Plan. The outcome of this service must be sustained paid employment and work experience leading to further career development and individual integrated community based employment for which the member is compensated at or above the minimum wage, and not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Work Support-Group does not include vocational services provided in a facility-based work setting in specialized facilities that are not part of the general workforce.
Work Support-Group may be used to support a member in a job that pays less than the minimum wage only if the employer complies with section 14(c) of the Fair Labor Standards Act ( 29 U.S.C. § 214(c)) and 26 M.R.S. §666.
Documentation must be maintained in the file of each member receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act ( 20 U.S.C. 1401et seq.).
Work Support-Group does not include volunteer work.
Work Support-Group cannot be used to cover incentive payments, subsidies, or unrelated vocational training expenses such as the following:
The cost of transportation related to the provision of Work Support-Group is a component of the rate paid for the service.
No more than six (6) members at one time may be supervised by a Direct Support Professional. The appropriate group rate must be billed.
The provider will submit a group work site schedule to the OADS Resource Coordinator listing members, work sites, units of service and staff. The provider will submit schedules quarterly thereafter to the Resource Coordinator.
Information must be provided to the member at least yearly that career planning and individual employment are available to them in order to make an informed decision.
Work Support-Individual must be provided to the member in an integrated employment setting in the general workforce and the member must be compensated at or above the minimum wage, and not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.
This service is provided after a member has received an assessment and services under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act and need for on-going support has been determined and documented in the Personal Plan. Work Support-Individual may be provided to self-employed members where the member requires support in operating his or her own business. Support may be used for Customized employment for members with severe disabilities - to include long term support to successfully maintain a job due to the ongoing nature of the member's support needs, changes in life situation, or evolving and changing job responsibilities. The primary focus of the support is job related and also encompasses adherence to workplace policies, safety, productivity, dress code, work schedule, building co-worker and supervisor relationships, hygiene and self-care.
Work Support-Individual does not include volunteer work.
"On Behalf of" is a component of Work Support-Individual and is included in the established authorization and is not a separate billable service.
Documentation must be maintained in the file of each member receiving this service that the service is not available under a program funded under section 110 of theRehabilitation Act of 1973 or the Individuals with Disabilities Education Act ( 20 U.S.C. 1401et seq.).
Work Support-Individual cannot be used to cover incentive payments, subsidies, or unrelated vocational training expenses such as the following:
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-29, subsec. 144-101-II-29.05