Section 21 and 29 Forms and Protocols

These protocols and forms are used by Case Managers supporting adults with Intellectual or Developmental Disability (IDD) and/or Autism, as well as Children’s and Mental Health Case Managers supporting adults who utilize MaineCare Benefits Manual Sections 21 and 29 waiver programs.

Protocols, Instructions, and Forms

The following documents help guide Case Managers to access resources available to the individuals and families they support, including how to complete various forms and submit initial classification packets, changes in service/authorization requests, Clinical Review Team requests, and annual reclassification packets.  All forms on this page are for case managers to use as templates. Please note that some forms must be saved in Word and cannot be scanned and emailed as an attachment. Forms in Excel must be saved in Excel or scanned and sent as an attachment (in PDF format).

Self-Direction Tools for Case Managers can be found on the Self-Direction Services page under Self-Direction Resources.

Please see the section on Clinical Review Team Guidelines for more information on the services the CRT approves before prior authorizations are entered.

PCP Forms are used by Children’s and Behavioral Health case managers /care coordinators who do not have access to the materials, assessments, and/or other information in our electronic record system (called Evergreen.) Access to Evergreen is not required to support people to apply for or access Waiver Services. These PCP Forms are used for ALL waiver processes.

Please click on the arrow to the left of the process to open the list of Protocols and Forms for each process below. When available, copies of PowerPoint presentations with more detailed instructions and examples are included.

Waiver Protocols & Forms for Developmental Disability Services Case Managers

Protocols

Forms

Clinical Review Team (CRT) Guidelines and Forms for Case Managers and Providers

Please note that the following services are only available for members on Section 21 except for Assistive Technology

Waiver Protocols & Application Forms for Children's & Behavioral Health Case Managers

Protocols

Section 21 and Section 29 Waiver Application Forms

Initial Classification Forms for Children's & Behavioral Health Case Managers

Annual Reclassification Forms for Children's & Behavioral Health Case Managers

Changes in Waiver Service for Children's & Behavioral Health Case Managers

Members Seeking Services (Vendor Call) Forms

Other Waiver-Related Forms

Other Forms and Resources