Developmental Services - Case Management Manual

Medical Services  

It is the Case Manager's responsibility to monitor the consumer's access to medical and dental services. For consumers who live with their families, the Case Manager may need to assist the family in locating a physician or dentist. Generally, the family will assume responsibility for making appointments and providing transportation.

A licensed residential provider has an obligation to assure that the consumer receives medical and dental services. The Case Manager should only assume this responsibility as a last resort, or in situations where the Case Manager has questions or concerns to relay to the physician or dentist.

The Case Manager needs to maintain records, copies of reports, etc. regarding the consumer's medical condition. The Case Manager needs to know who the primary physician is, and the status of any acute or chronic medical problems. The Case Manager communicates this information to persons involved with the consumer who "need to know" the consumer's medical condition.
For most consumers, either Medicaid or Medicare will reimburse medical expenses. Certain medical services and supplies can only be received with prior authorization from the Division of Medical Claims Review, Department of Human Services (289-3081). Rules covering medical 
services and reimbursement can be located in the Maine Medical Assistance Manual.

Dental services are generally not reimbursable, except for children.