Maine

Main Contact: 
Nicole Rooney: Nicole[dot]Rooney[at]maine[dot]gov
NWD/SEP System
Name of Operating Agency: 
Maine Department of Health and Human Services (DHHS)
Participating types of NWD/SEPs: 
Five ADRCs, a CIL, and Department of Health and Human Services (DHHS) offices will provide statewide coverage
1-800 number: 
Maine 211
Level I screen: 
The Level I screen will be accessible through the 211 number, ARDCs, the CIL, and the DHHS offices, as well as online with MaineLink
Level II assessment: 
A Single Assessment Agency (Goold Health Systems) will conduct the Level II screen
Agency responsible for completing the financial assessment: 
Maine DHHS, Office of Family Independence
Coordination/automation of referrals between levels (i.e., Level I and Level II) : 
Completing the Level I screen will result in an automatic referral to the Single Assessment Agency
Core Standardized Assessment
Elderly individuals (age 65 or older): 
MED Assesment
People with developmental disabilities: 
DS Comprehensive and support; HCB Waiver Assessment (BMS-99); PASRR II Pyschosocial and Function Evaluation; PASRR I Screen; Medical Eligibility Determination (MED) Kids-KB assessment (Children only); MED Kids-PDN Assessment (Children only); Supports Inte
People with a serious mental illness or severe emotional disturbance: 
Level of Care utilization System (LOCUS); Adult Needs and Strengths Assessment (ANSA); ISP; PASRR I and II; MED Kids-KB Assessment (Children only); MED Kids-PDN Assessment (Children only); Supports Intensity Scale (Children only)
People with physical disabilities: 
MED Assessment; MED Kids-KB assessment (Children Only); MED Kids-PDN assessment (Children only); Supports Intensity Scale (SIS) (Children only); Brain Injury Assessment Tool for Section 97 Eligibility for Residential Services (TBI individuals)
Conflict-Free Case Management
Mitigation strategies in place/planned: 
Maine has identified areas in mental health services where community support providers determine functional eligibility for community support and services and provide direct services. Maine is working with the mental health office to draft policy revision
Service data: 

Maine will make use of claims data and encounter data. ME will use the CMS 372 (Medicaid Waivers) Form Reports to establish that the programs are cost effective and cost neutral and to report participation levels for the services rendered to individuals and families who meet the eligibility criteria in each waiver. It will also use National Medicaid HCBS data to note expenditures by their service categories, and use CMS 64 Form Reports to judge participants access to both community and institution LTSS.

Quality measures: 

Medicaid Adult Health Quality

NCQA/HEDIS measures

MFP Quality of Life Survey
 

Outcomes data: 

Maine will use an Adult Mental Health and Well Being Survey, which is mailed to individuals receiving mental health services in the previous eight months from MaineCare Section 17 Community Support Services or Section 97 Services Adult Residential Services (Private Non-Medical Institutions). This will measure service access, quality and appropriateness of services, satisfaction and functioning. It will also use a LTSS Provider survey to measure service access, quality and appropriateness services, satisfaction and functioning from all participating statewide providers.

Use of Enhanced FMAP: 

Maine will use the enhanced FMAP to support structural changes, increase waiver slots for its home and community benefits for members with ID/DD and physical disabilities, develop curriculum for Direct Care Worker training, conduct studies to inform which services to write into 1915(c) waivers for the aging and physcially disabled, and develop and Olmstead Plan for community LTSS versus institutionalization for all populations.