Maine § 22 §3174-I Medicaid eligibility determinations for applicants to nursing homes

Maine Statutes

§ 22 §3174-I — Medicaid eligibility determinations for applicants to nursing homes

Maine·Title 22 HEALTH AND WELFARE·Part 1 ADMINISTRATION·Ch. 855 AID TO NEEDY PERSONS

1.Needs assessment. In order to determine the most cost-effective and clinically appropriate level of long-term care services, the department or its designee shall assess the medical and social needs of each applicant to a nursing facility. If the department chooses a designee to carry out assessments under this section, it shall ensure that the assessments are comprehensive and objective. 1-A. Information and assistance. If the assessment performed pursuant to subsection 1 finds the level of nursing facility care clinically appropriate, the department shall determine whether the applicant also could live appropriately and cost-effectively at home or in some other community-based setting if home-based or community-based services were available to the applicant. If the department determine

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1.
Needs assessment.
In order to determine the most cost-effective and clinically appropriate level of long-term care services, the department or its designee shall assess the medical and social needs of each applicant to a nursing facility. If the department chooses a designee to carry out assessments under this section, it shall ensure that the assessments are comprehensive and objective.
1-A.
Information and assistance.
If the assessment performed pursuant to subsection 1 finds the level of nursing facility care clinically appropriate, the department shall determine whether the applicant also could live appropriately and cost-effectively at home or in some other community-based setting if home-based or community-based services were available to the applicant. If the department determines that a home or other community-based setting is clinically appropriate and cost-effective, the department shall:
1-B.
Notification by hospitals.
Whenever a hospital determines that a patient will require long-term care services upon discharge from the hospital, the hospital shall notify the department prior to discharge that long-term care services are indicated and that a preadmission assessment must be performed under this section.
2.
Assessment for mental illness, intellectual disability, autism or related conditions.
The department shall assess every applicant to a nursing facility to screen for mental illness, intellectual disability, autism or other related conditions in accordance with the federal Nursing Home Reform Act, Public Law 100-203, Section 4211, 42 United States Code, Section 1396r. Such assessments are intended to increase the probability that any individual who has an intellectual disability, autism or other related condition or a mental illness will receive active treatment for that individual's condition.
3.
Rules.
The Department of Health and Human Services shall adopt rules in accordance with the Maine Administrative Procedure Act, Title 5, chapter 375, to implement this section.

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Legislative History

PL 1989, c. 498 (NEW). PL 1993, c. 410, §§FF10-12 (AMD). PL 1993, c. 410, §FF19 (AFF). PL 1995, c. 170, §§2,3 (AMD). PL 1995, c. 687, §1 (AMD). PL 1995, c. 696, §B1 (AMD). PL 2003, c. 689, §B6 (REV). PL 2011, c. 542, Pt. A, §33 (AMD). PL 2011, c. 657, Pt. BB, §2 (AMD).