Subsection 144-101-II-89.04 - ENROLLMENT AND DUPLICATION OF SERVICES89.04-1Member IdentificationThe MaineMOM provider shall identify members who are potentially eligible for services under Section 89.03. The MaineMOM provider will submit potentially eligible members to the Department or the Department's Authorized Entity through a certification process to approve services. Each member's eligibility must be based on a diagnosis rendered within the past year from the date of the certification request.
89.04-2Enrollment and Duplication of ServicesA.Enrollment: The MaineMOM provider shall identify members for services based on the service eligibility criteria. The provider shall give potentially eligible members information about the benefits of participating in MaineMOM services. The member can choose to receive services once confirmed eligible. The Department, or its Authorized Entity, must approve members through a certification process with the certification effective the earliest date without risk of duplicative services. The member can choose not to participate in MaineMOM services at any time by notifying the MaineMOM provider, the Department, or its Authorized Entity, for certifications of services.B.Duplication of Services: As set forth in Section 89.09 (Reimbursement), the Department will not reimburse for duplicative services for members. If the Department, or its Authorized Entity, determines the member is receiving a duplicative service through a certification process, the member chooses which service they want to receive. The Department, or its Authorized Entity, will notify members that they cannot receive duplicative services and will keep a record of documentation as to the members' choice of service. A member may only be in one health home program at a time.C.Requests and Referrals: Members may request MaineMOM services or be referred for services through the Department's maternal and child health referral system. MaineMOM providers must provide a referral contact at their service location to facilitate the connection to services.D.Documentation of Consent: MaineMOM providers must retain documentation of consent for all members in the member record. Consent documentation must, at a minimum: 1. Indicate that the individual has received information explaining the purpose of MaineMOM services and the services provided; and2. Indicate that the individual has consented to receive the MaineMOM services and understands their right to choose, change, or disenroll from their MaineMOM provider at any time.89.04-3ASAM CriteriaMaineMOM providers shall assess the appropriateness of MaineMOM services in alignment with the ASAM level of care criteria. Members must minimally meet ASAM Level 0.5 or Level I for individual, family, or group outpatient services.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-89, subsec. 144-101-II-89.04