Section 197-11-02 - ELIGIBILITY FOR SERVICES(A)General and Specific Requirements. To be eligible for services a consumer must: (2) Live in Maine; "Live in Maine" means to have legal residence in Maine and be present in Maine for 183 days of the year, except for Maine resident students attending school. consumer's relocating may be allowed up to one month's program services to assist the consumer to make a transition to other services;(3) Lack sufficient personal and/or financial resources for in-home services;(4) Be ineligible for the MaineCare Private Duty Nursing Personal Assistance Services, MaineCare Adult Day Health, MaineCare Consumer Directed Assistant Services programs. consumer's who are eligible for the MaineCare Home and Community Based Waiver program may be deemed eligible for supplemental funds under this program, subject to availability of funds;(5) Not be residing in a hospital or nursing facility;(6) Agree to pay the monthly calculated consumer payment. This payment may be subsequently waived or reduced if the consumer's application for a waiver or reduction is approved.(7) Not have a guardian or a conservator:(8) Eligibility for the Consumer Directed HBC Program requires a significant level of skill and responsibility from the consumer. In order to be eligible for CDHBC services, a consumer must be capable of performing all the tasks and responsibilities of an employer. In order to best determine the applicant's ability to function in this role, the Authorized Agent will assess the individual's cognitive abilities as follows:(A) Based on actual performance during skills training. The assessor will review the consumer's ability to understand and retain the elements included in the regular course of consumer skills training. (A) In actual performance as a consumer of program services. During the course of using program services, and particularly during the first year of service, the Authorized Agent will continually assess the consumer's ability to successfully participate in the Program. Included in skills training will be: (1) Understanding of the consumer's disability, including health issues and relevant adaptive equipment and ability to explain disability to others;(2) Ability to understand and communicate assistance needs;(3) Ability to understand and communicate safe and unsafe conditions;(4) Ability to handle finances associated with the program;(5) Ability to communicate effectively in writing, verbally or using adaptive equipment;(6) Demonstrated ability to direct others as needed in an employment relationship;(7) Ability to create and carry out daily work plans for PAs;(8) Understanding of local resources and ability to self refer for needed services;(9) Demonstrated ability to create and carry out a hire plan for PAs;(10) Ability to train and supervise PAs;(11) Ability to retain PAs as employees;(12) Ability to successfully carry out the responsibilities of program consumer's as specified in the Department's rules;(13) Demonstrated understanding of HIPAA confidentiality requirements. At any point during the initial evaluation, or in the course of ongoing service, that the Authorized Agent determines the consumer is unable to carry out the requirements of this section, the consumer will be found ineligible for the program.
(9) The individual must agree to undergo consumer instruction and testing within thirty (30) days of the assessment in order to develop and verify that they have attained the skills needed to hire, train, schedule, supervise, and document the provision of Personal Assistance Services identified in the authorized plan of service. consumer's who do not complete the instruction or do not demonstrate to the Authorized Agent that they have attained the skills needed to hire, fire, train, schedule, supervise and document the delivery of their identified care services, are not eligible for services under this Section;(10) The consumer may not reside in a licensed residential setting. The individual's residence, while using Consumer Directed Home Based Care Services, may be the individual's home or a transitional living program. Personal Assistance Services cannot be delivered in an Adult Family Care Home (AFCH) setting or other licensed Assisted Living Facility which is currently reimbursed by state and/or federal funds for providing Personal Assistant Services; and(11) If the assessment for continued eligibility indicates medical eligibility for a MaineCare program and potential financial eligibility for MaineCare, consumer's will be given written notice that the consumer has up to thirty (30) days to file a MaineCare application. If Personal Assistance Services are currently being received, services shall be discontinued if an Office of Integrated Access and Support notice is not received within thirty (30) days of the assessment date indicating that a financial application has been filed. Services shall also be discontinued if, after filing the application within thirty (30) days, the application requirements have not been completed in the time required by MaineCare policy.(12) If individuals are deemed not eligible for the program, efforts will be made to provide information and referral services to assist consumer's in reaching appropriate service alternatives.(B)Medical and Functional Eligibility Requirements(1) A person meets the medical eligibility requirements for Consumer Directed Home Based Care if he or she requires limited assistance plus a one person physical assist with at least two (2) ADLs from the following: bed mobility, transfer, locomotion, eating, toilet use, dressing, and bathing.(a) Activities of Daily Living:(a) Bed Mobility: How person moves to and from lying position, turns side to side, and positions body while in bed;(b) Transfer: How person moves between surfaces to/from: bed, wheelchair, standing position (excluding to/from bath/toilet);(c) Locomotion: How person moves between locations, in room and other areas. If in wheelchair, self-sufficiency once in chair;(d) Eating: How person eats and drinks;(e) Toilet Use: How person uses the toilet room (or commode, bedpan, urinal): transfers on/off toilet, cleanses, changes pad, manages ostomy or catheter, adjusts clothes;(f) Bathing: How person takes full-body bath/shower, sponge bath and transfers in/out of tub/shower; and(g) Dressing: How person puts on, fastens, and takes off all items of street clothing, including donning/removing prosthesis.(2) Must have the cognitive capacity, measured on the MED form, as defined in Section 11.01, to be able to direct the services. The Authorized Agent as part of the assessment will determine this capability;(3) The individual must agree to complete initial consumer instruction and testing within thirty (30) days of date of the completion of the MED form to determine medical eligibility in order to develop and verify that they have attained the skills needed to hire, train, schedule and supervise assistants, and document the provision of personal assistance services identified in the Authorized Plan of Service. consumer's who do not complete the course of instruction or do not demonstrate to the Authorized Agency they have attained the skills needed to hire or select, fire, and train assistants, schedule, supervise and document the delivery of their identified care services, are not eligible under this section.14- 197 C.M.R. ch. 11, § 02