C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-46, subsec. 144-101-II-46.01
Active treatment means implementation of a professionally developed and supervised individual plan of care that is designed to achieve the member's discharge from inpatient services at the earliest time possible.
Authorized Agent means the organization authorized by the Department of Health and Human Services (DHHS) to perform specified functions including, but not limited, to prior authorization and/or utilization review pursuant to a signed contract or other approved signed agreement.
Community Care means services not provided in a hospital setting and provided to a member in his/her place of residence, regardless of whether the member is residing with biological family, adoptive family, foster parents, therapeutic parents or in Intensive Temporary Out of Home Treatment.
An emergency psychiatric inpatient admission means any admission of a patient who requires immediate psychiatric hospitalization due to the patient's risk of harm to self and/or others and the patient's inability to manage in a less restrictive environment without further regression.
Inpatient Services in this Section means services furnished in a psychiatric hospital for patients who have been admitted to the hospital for twenty four (24)-hour-a-day acute psychiatric care. MaineCare only covers inpatient psychiatric services for members under age twenty-one (21) or age sixty five (65) and older.
A Mental Health Clinician means a Physician, Psychiatrist, Clinical Psychologist, Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker, Licensed Master Social Worker Conditional Clinical (LMSW-CC), Licensed Clinical Professional Counselor (LCPC), Licensed Professional Counselor (LPC), Licensed Marriage Family Therapist (LMFT), Advanced Practice Registered Nurse Psychiatric and Mental Health Practitioner (APRN-PMH-NP), or an Advanced Practice Registered Nurse Psychiatric and Mental Health Clinical Nurse Specialist (APRN-PMH-CNS) when practicing within their scope of licensure to make a diagnosis.
Outpatient services means a planned combination of diagnostic, treatment and rehabilitative services provided to mentally or emotionally disturbed members in the hospital setting on a less than twenty-four (24) hour a day basis. Outpatient services are intended to provide support and facilitate a more integrated and independent level of functioning in the community to members with psychiatric disorders.
Partial Hospitalization Services means a supervised rehabilitative-oriented treatment by a mental health clinician lasting more than two (2) hours but less than twelve (12) hours each day in a psychiatric hospital that provides a combination of evaluative, diagnostic, treatment and rehabilitative services to persons with psychiatric problems.
Psychiatric Hospital means a hospital that is primarily engaged in providing psychiatric services for the diagnosis, treatment and care of persons with mental illness. A psychiatric hospital must be licensed as a psychiatric hospital by the Department of Health and Human Services (DHHS).
Serious Emotional Disturbance (SED) means when a member has a mental health, emotional or behavioral diagnosis, under the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), that has lasted for or can be expected to last for at least one (1) year, and is at risk for more restrictive placement, including but not limited to, psychiatric hospitalization, as a result of this condition for which other less intensive levels of service have not been effective (e.g. traditional outpatient services).
An inpatient psychiatric unit that solely serves members under the age of 21 with developmental disorders and staffed by a child psychiatrist and psychologist with specific training and expertise in the assessment and treatment of this population. This unit utilizes an evidence-based, bio-behavioral approach based upon intensive data collection and observable measures; and utilizes a multi-disciplinary team approach to address speech pathology, occupational therapy, special education, nursing and social work needs.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-46, subsec. 144-101-II-46.01