Adult Services

Community Integration (CI) Services involve biopsychological assessment of the member, evaluation of community services and natural supports needed by the member who satisfies the eligibility requirements of Section 17.02, and rapport building through assertive engagement and linking to necessary natural supports and community services while providing ongoing assessment of the efficacy of those services. Community Integration Services involve active participation by the member or guardian. The services also involve active participation by the member's family or significant other, unless their participation is not feasible or is contrary to the wishes of the member or guardian. These services are provided as indicated on the ISP. These services may not be provided in a group.

• Adult CI CSR Submission Guidelines
• Community Support Services Clinical Eligibility Determination Form

Community Rehabilitation Services (CRS) support the development of the necessary skills for living in the community, and promote recovery, and community inclusion. Services include individualized combinations of the following, and are delivered by a team, with primary case management for each member assigned to one team member.

Assertive Community Treatment (ACT) provides individualized intensive integrated services that are delivered by a multi-disciplinary team of practitioners and are available twenty-four (24) hours a day, 365 days a year. ACT services are delivered primarily in the community and not in an office based setting. Assertive interventions, including street outreach, are employed by the team as appropriate. ACT teams must provide at least on average, per member, three (3) face-to-face contacts with the member per week.

• Section 17 Adult ACT Clinical Documentation Guidelines
• ACT Prior Authorization Submission Guidelines
• ACT CSR Submission Guidelines

Daily Living Support Services (DLS) are designed to assist a member to maintain the highest level of independence possible. The services provide personal supervision and therapeutic support to assist members to develop and maintain the skills of daily living. The services help members remain oriented, healthy, and safe. Without these supportive services, members likely would not be able to retain community tenure and would require crisis intervention or hospitalization. These services are provided to members in or from their homes or temporary living quarters in accordance with an individual support plan. Support methods include modeling, cueing, and coaching.

Skills Development Services involve face-to-face contact with the member with or without family or non-professional caregivers that restore and improve the member’s skills and abilities essential to independent living (i.e. self-care and daily life management). Services may be provided to an individual or in a group setting and are targeted to enhance access to community resources, with natural supports, increase independence to promote successful community integration. Skill enhancement is provided through structured interventions for attaining goals identified in the ISP. Progress on goals will be reviewed at least every 90 days to determine the efficacy of the services and natural supports and to formulate changes in the plan as necessary.

Day Supports Services formerly known as “day treatment”, focus on training designed to assist the member in the acquisition, retention, or improvement of self-help, socialization, and adaptive skills. These services take place in an agency environment.

Psychiatric Hospital is 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).

Covered services include those services ordinarily provided in a psychiatric hospital for the 24-hour care and treatment of an inpatient under the supervision of a psychiatrist and in accordance with the member's plan of care.

The provider shall provide an intensive and structured service of alcohol and drug assessment, diagnosis, including co-occurring mental health and substance abuse diagnoses, and treatment services in a non-residential setting aimed at members who meet ASAM placement criteria level II.1 or level II.5. IOP may include individual, group, or family counseling as part of a comprehensive treatment plan. The provider will make provisions for the utilization of community resources to supply client services when the program is unable to deliver them. Each program shall have a written agreement with, or, shall employ, a physician and other professional personnel to assure appropriate supervision and medical review and approval of services provided.

A Private Non-Medical Institution (PNMI) is defined as an agency or facility that is not, as a matter of regular business, a health insuring organization, hospital, nursing home, or a community health care center, that provides food, shelter, personal care, and treatment services to four or more residents in single or multiple facilities or scattered site facilities. Private Non-Medical Institution services or facilities must be licensed by the Department of Health and Human Services, or must meet comparable licensure standards and/or requirements and staffing patterns as determined by the Department specified in Section 97.01 (A-F). For agencies serving persons with intellectual disabilities in scattered site PNMIs, comparable licensure standards means those required by rule for community support services as described in Mental Health Agency Licensing Standards and Rights of Recipients of Mental Health Services, Regulations for Licensing and Certification of Alcohol and Drug Treatment Services.

• MaineCare Funded Service Grid

• Medical Necessity Physician Order Form
• Authorization to Release Information Form
• Authorization to Release Information Form Example