Developmental Services - Case Management Manual

Developmental Services Class Requirements

Waiver

Waiver - Initial Reclassification ICF/MR Group or Nursing Classification
  1. All participants in this program must be determined to be financially eligible for MaineCare, Medicaid benefits. The Bureau of Family Independence (BFI) does this.
  2. There must be a current Individual Support Plan, less than one year old at time of classification, consumer or guardian if appropriate must sign plan. Plan must detail why there is a need for waiver services and that there is an apparent need for ICF-MR level of care and services.
  3. A signed Choice Letter dated after the date of the above plan, but before the first date of waiver services.
  4. A completed BMS-99 form signed by attending physician. Signature must be less than sixty day’s old as of the date of received in the Central Office Waiver Services Division.
  5. A completed and signed waiver checklist that details the authorization of particular waiver services.
  6. If the consumer is found to be both financial and medically and there is an opening available for them they will be so notified by the Central Office staff.
  1. Participant must continue on-going Medicaid eligibility.
  2. Updated support plan less than one year old as of date for reclassification. There needs to be detail as to why this need is on going or remains in effect.
  3. An updated BMS –99 form that does not require a physician signature.
  4. A signed waiver checklist that details current authorizations.
  5. The above information is due in Central Office by the date of classification.
  6. Reclassification applications received after thirty working days of the review date shall be authorized for services as of the date the reclassification application is received.
  7. When the reclassification packet has not be received and processed after thirty-calendar days beyond the due date payment to the provider will stop, until such time that the classification is completed.
  1. Participant must be determined financially eligible for MaineCare benefits for this level of care.
  2. A recent plan of care less than six months old needs to recommend such placement. This most commonly is the pre-placement meeting that takes place less than 30 day’s prior to placement.
  3. A psychological evaluation that is less than one year old. This should document that the individual is likely to benefit from the placement into such a facility.
  4. A completed BMS-85 form and physical signed by a physician that is completed no sooner than seven day’s prior to admission and no later than forty-eight hours following admission.
  5. It is the responsibility of the receiving facility to make sure that number four above is completed, however case-management staff will often assist with this responsibility.

 

Developmental Services cannot classify an individual going into a State facility. That is done by:

  • BMS Classification Review
    State House Station #11
    Augusta, Maine 04333
    Telephone # 287-3931

Payment will not be made until individuals are classified