Provider Update 6/6/08

Level of Care Criteria Revisions

The Maine Behavioral Health ASO Level of Care Criteria has been revised consistent with changes in MaineCare policy and the Bates vs. DHHS Consent Decree.  The changes are as follows:

• Level of Care Criteria for these services have been removed:

  • Intensive Community Integration

  • Targeted Case Management – Maine Adoptive Guides ONLY

  • Children’s Section 65 Day Treatment Services

  • Infant Mental Health Services

• Children’s PNMI Intensive Residential Continued Stay Criteria has been revised to ensure that the criteria are fully consistent with MaineCare and DHHS requirements.  The changes are on page 49, and are highlighted in yellow.

• The following revisions have been made to ensure consistency with the Bates vs. DHHS Consent Decree:

  • The page labeled “Introduction” includes the following language in conspicuous print.  “The Level of Care Criteria are offered as interpretive clinical guidelines for proper application of the MaineCare rules.  In the event of conflict between the rules and the guidelines, determinations of initial or continuing eligibility shall be controlled by the applicable MaineCare rules.”

• The references to section 17.02-3(B) throughout the Adult Services LOC Criteria, be corrected to 17.02-3(A)(2)(a)(I-vi).

• The language below the heading for Adult Services Section 65, Crisis Support Services (page 18), is amended to read as follows.  “Services may extend for several days, but clinical discussions of continuing eligibility and need shall occur, at the latest, within ten days of the precipitating psychiatric emergency.”