Subsection 144-101-II-94.04 - HEALTH PROMOTION94.04-1Informing and Periodicity MaineCare will inform all members about the availability of Early and Periodic Screening, Diagnosis and Treatment within sixty (60) calendardays of their enrollment in MaineCare and in the case of families that have not utilized such services, annually thereafter.
MaineCare will notify members that a health assessment visit is due by the first of the month in which visits are due according to the MaineCare Bright Futures periodic health assessment schedule (Appendix 1).
94.04-2Special Assistance for Members under Age 21 MaineCare will provide the following assistance to members.
A. Arrange or schedule appointments for services or treatment for problems found as a result of a health assessment visit.B. Find a MaineCare provider.C. Arrange transportation.D. Make referrals for follow-up by the Maine Department of Health and Human Services, Centers for Disease Control and Prevention, Public Health Nursing (PHN) staff or nursing staff under contract with the Centers for Disease Control and Prevention to perform PHN functions for, but not limited to, the following reasons. The child: 1. does not have a primary care provider;2. is significantly behind in his/her immunizations;3. is missing appointments with his or her provider(s); or4. needs a repeat blood lead test. Providers may use the MaineCare Bright Futures health assessment form to request a referral to the Centers for Disease Control and Prevention or may call or fax the Health Care Management Unit of MaineCare Services.
E. Help with issues identified as a result of a health assessment visit when requested by the provider.F. Provide information in alternative formats such as Braille or provide interpreter services for members who are deaf/hard of hearing or who are non-English or limited English speaking.94.04-3Home Visits for Children Age Two and UnderA. MaineCare will pay for home visits for families with a child age two and under who is enrolled in MaineCare when one or more of the following risk criteria exist: 1. The infant or child: a. had a birth weight under 2500 grams;b. was born pre-term, i.e. under 37 weeks; and/orc. has a chronic illness or disability.2. The infant or child's: a. mother is single and was under 20 years of age at the time of birth; orb. parents have been diagnosed with mental retardation.3. There is a history of substance abuse in the household, excluding nicotine use or abuse. Home visit services are direct services provided by a registered nurse or other trained professional in accordance with a plan of care approved by the child's physician, physician's assistant or advanced practice registered nurse. Home visit services are not case management. MaineCare will pay for up to 2.5 hours of direct services provided in the home per family per month.
B. Staff at the following clinics, agencies, and centers may provide services through home visits, ambulatory care clinics, home health agencies, Federally Qualified Health Centers and Rural Health Clinics. Staff providing services through home visits must work within the scope of their licenses and any additional restrictions of the agencies employing them. Prior to doing a home visit, these staff members must: 1. develop a plan of care based on the risk criterion being addressed,2. make sure the plan is approved by the child's physician, physician's assistant, or advanced practice registered nurse, and3. request and receive prior authorization from the MaineCare Prior Authorization (PA) Unit of MaineCare Service. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-94, subsec. 144-101-II-94.04