Subsection 144-101-II-40.03 - DURATION OF CAREEach MaineCare member is eligible to receive as many covered services as are medically necessary as long as the member meets the eligibility requirements as set forth in Section 40.02, and services are provided in accordance with a valid, authorized certification period as required in Section 40.08-1.D., and there has been a valid Authorization Process and certification has been obtained. (see 40.02-1). The Department reserves the right to request additional information to evaluate medical necessity. Coverage will be denied if the services provided are not specified in the authorized plan of care. Home Health Services shall be reduced, denied, or terminated by the Authorized Entity or the Department, as appropriate, if any of the following situations occur:
A. The member declines Home Health Services;B. A significant change occurs in the member's medical or functional status such that a plan of care can no longer be developed and implemented safely;C. The member does not meet the medical eligibility criteria for Home Health Services as set forth in Section 40.02-4, as determined by the Authorized Entity or the Department;D. The member is not financially eligible to receive MaineCare benefits as set forth in Section 40. 02-3 as determined by the Department;E. When the member's most recent assessment, and the clinical judgment of the Authorized Entity, determine that the authorized plan of care must be changed or reduced to match the member's needs as identified in the assessment, the plan of care shall be modified by the Authorized Entity, or the Department, to reflect the change in needs;F. The member has provided fraudulent information in connection with obtaining services;G. The Department, or the Authorized Entity, documents that the member, or other person living or visiting the member's residence, harasses, threatens or endangers the safety of individuals delivering services. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-40, subsec. 144-101-II-40.03