Developmental Services - MaineCare
Consumers who are eligible by State statute for Developmental Services and meet the applicable eligibility requirements for the State’s Medicaid program, known as MaineCare, are eligible for medically necessary services described in the MaineCare Benefits Manual. In addition to general coverage, certain services within specific Sections of policy are designed for individuals who are served under Developmental Services.
The MaineCare Benefits Manual is made up of three main Chapters of interest to consumers, families and providers; Chapter I includes the overarching General Administrative Policies and Procedures that apply to all of MaineCare, Chapter II is a narrative description of each of the individual policies (know as “Sections”), Chapter III identifies the reimbursement and billing procedures associated with each of the Sections described in Chapter II.
The specific Sections (policies) of MaineCare that may be available to those served under Developmental Services are as follows:
- Section 13, Targeted Case Management: One sub-section of the case management policy applies to those eligible for Developmental Services. Case management is a service that assists in the planning and coordination of services and is provided by a mix of state-employed and contracted case managers:
- Section 21, Home and Community Based Waiver (“Comprehensive Waiver”): The Comprehensive
Waiver offers a broad mix of services including Home Support, Community Support and Work Support. Other
services are available and may be recommended for participants through the person centered planning
- Chapter II (word*)
- Chapter III (word*)
- Section 21 Rate Tables (1 & 2) and Rate Calculator: (excel)
- Section 29, Home and Community Based Waiver (“Support Waiver”): The Support Waiver offers supportive services to consumers who live with their families or on their own. The primary services are Community Support and Work Support. There is also a mix of other services that may recommended by the person centered planning team.
- Section 50, Intermediate Care Facility for Individuals with Intellectual Disabilities: Known as the ICF/IID program, this is considered an “institutional” setting designed to meet the intensive active treatment needs of consumers. Maine’s ICF/IID program has two categories of facilities, Group and Nursing. All homes serve 16 or fewer consumers and the difference between the two is related to the complexity of individuals’ medical needs.
- Section 97 (Appendix F), Private Non-Medical Institution (Medical & Remedial): PNMI’s, as these homes are known, are licensed group homes that generally serve six to eight consumers. The homes may be either proprietary or agency operated and have 24/7 staff. MaineCare is used to pay for staffing and some administrative costs and state funds and consumer contributions pay for room and board.