A copy of the member's Personal Plan developed, approved and signed by the member, guardian and the Case Manager within the preceding six months of the effective plan date and any other relevant material indicating the member's service needs.īased on review of the Assessment Form and the member's Personal Plan, a QIDP designated by DHHS will determine the member's medical eligibility for services under this Section.ĭHHS shall notify each member or the member's guardian in writing of any decision regarding the member's medical eligibility, and the availability of benefit openings under this Section. A completed copy of the assessment form (BMS99) or current functional assessment approved by the DHHS andī. In order to determine medical eligibility, the member and Case Manager must provide to DHHS the following:Ī. The estimated annual cost of the member's services under the waiver is equal to or less than two hundred percent (200%) of the state-wide average annual cost of care for an individual in an ICF/IID, as determined by the DHHS.
#Eis dhhs maine manual
Meets all MaineCare eligibility requirements as set forth in the MaineCare Eligibility Manual andį. Does not receive services under any other federally approved MaineCare home and community based waiver program andĮ. Meets the medical eligibility criteria for admission to an ICF/IID as set forth under the MaineCare Benefits Manual, Chapter II, Section 50 andĭ. Has an Intellectual Disability as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association) (DSM) or Autism Spectrum Disorder as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders,(American Psychiatric Association) or Rett Syndrome as defined by the DSM andĬ. Is age eighteen (18) or older (members who were younger than age 18 and were already receiving services under this Section as of Decemmay continue to receive benefits under this Section) andī. The number reserved for members in out of state residential placements is based on the number of current out of state residential placements funded by MaineCare or State funds.Ĭonsistent with Subsection 21.03-1, a person is eligible for services under this Section if the person:Ī. The number reserved for ICF/IID, long term nursing home placement, state psychiatric hospital or hospital residents is based on currently known referrals.
The number reserved associated with Section 21.03-2 above is an average based on the DHHS's data for those in need of adult protective services in recent years. Meet the needs of members under age 21 in out of state residential placements funded by MaineCare or State funds.Meet the needs of those individuals who choose to leave an ICF/IID, long term nursing home placement, state psychiatric hospital, or hospital and.Meet the needs of incapacitated or dependent adults who require adult protective services to alleviate the risk of serious harm resulting from abuse, neglect and/or exploitation and.The DHHS reserves a portion of member capacity of the waiver for specified purposes subject to CMS review and approval in order to:
Persons who would otherwise be eligible for services under this Section are not eligible to receive services if all of the funded openings are filled.
The number of MaineCare members that can receive services under this Section is limited to the number, or "funded openings," and point in time approved by the Centers for Medicare and Medicaid Services (CMS). DETERMINATION OF ELIGIBILITYĮligibility for this benefit is based on meeting all three of the following criteria:ġ) the eligibility criteria for a funded opening based on priority,ģ) eligibility for MaineCare as determined by the DHHS, Office for Family Independence (OFI).
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