Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-97 - Private Non-Medical Institution Services › Subsection 144-101-II-97.07 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
97.07-1
Setting
Services shall be delivered in the Private Non-Medical
						Institution or other settings appropriate to individual service needs in
						accordance with an individual service plan.
97.07-2
Qualified Staff
A Private Non-Medical Institution may be reimbursed for
						services provided by the following staff and as set forth in the Chapter III,
						Principles of Reimbursement for that type of institution:
A.
Professional Staff
All professional staff must be conditionally,
						temporarily, or fully licensed and approved to practice as documented by
						written evidence from the appropriate governing body.
MaineCare may reimburse a PNMI for covered services as
						defined in Section
						97.04 if they are
						provided by the following professional staff members: dentist, licensed alcohol
						and drug counselor, licensed clinical professional counselor, licensed
						professional counselor, nurse practitioner, occupational therapist registered,
						physician, physician assistant, licensed practical nurse, psychiatrist,
						psychiatric nurse, psychologist, psychological examiner, registered nurse,
						social worker, or speech language pathologist. All providers must hold
						appropriate licensure in the state or Province in which services are provided
						and must practice within the scope of these licensing guidelines. See Appendix
						D of Section
						97, Chapter III, for PNMI covered
						services.
B.
Other
					 Qualified Mental Health Staff
Other staff may be considered qualified for purposes of
						this Section if they meet the following requirements:
1. They have education, training, or
					 experience that qualifies them to perform certain specified mental health
					 functions;
2. They receive
					 certification from the Department, or its designee, that they are qualified to
					 perform such functions and such verification is recorded in writing and kept in
					 the files of the Department, or its designee; and
3. They perform such functions under the
					 supervision of a licensed, certified, or registered health professional with
					 the supervisory relationship having been described to and approved by the
					 Department in accordance with its licensing and certification
					 regulations.
C.
Other Qualified Medical and Remedial Services Staff
Medical and remedial services and personal care services
						staff members may be considered qualified for purposes of this Section if they
						meet the following requirements:
1.
					 The services they provide are prescribed by a physician and are in accordance
					 with the member's plan of care.
2.
					 The facility has written documentation that each staff person has received
					 orientation or is currently in orientation in keeping with the licensing
					 regulations for medical and remedial services facilities cited in Section
					 97.01-1(D) and is adequately performing medical and remedial services according
					 to minimum standards set by the Office of MaineCare Services identified in the
					 regulations cited above.
3. The
					 medical and remedial services staff person is not a member of the member's
					 family as defined in the Chapter III, Principles of Reimbursement for Medical
					 and Remedial Service Facilities.
D.
Other Qualified Alcohol and Drug
					 Treatment Staff
Other qualified alcohol and drug treatment staff are
						staff members, other than professional staff defined above, who have
						appropriate education, training and experience in substance use treatment
						services, related disciplines as approved by the Office of Behavioral Health,
						or behavioral sciences; who work under a substance use treatment professional,
						consisting of at least one (1) hour per week for each twenty (20) hours of
						covered services rendered; and who are approved by the State Board of
Alcohol and Drug Counseling as documented by written
						evidence on file with that office pursuant to Section 4.19 of the Regulations
						for Licensing/Certifying Substance Use Treatment Facilities in the State of
						Maine. A Certified Alcohol and Drug Counselor is considered to be an other
						qualified substance use staff member.
E.
Personal Care Service Staff
Personal care service staff may be considered qualified
						for purposes of this Section if they meet the following requirements:
1. The personal care services provided by all
					 PNMIs are prescribed by a physician upon or within thirty (30) days of
					 admission, are in accordance with the member's plan of care, are supervised by
					 a registered nurse at least every ninety (90) days, and are not provided by a
					 member of the member's family as described in Section 97.01-6 or the pertinent
					 Appendix of Chapter III, Principles of Reimbursement.
2. The following facilities shall have
					 written documentation that each staff person has received orientation in
					 keeping with the licensing regulations for:
a) community residences for people with
					 mental illness, cited in Section 97.01-1(C) or,
b) as outlined in the residential services
					 agreement required by the Department of Health and Human Services licensing
					 requirements cited in Section 97.01-1(E); or
c) in accordance with licensing regulations
					 for residential substance use treatment PNMIs as cited in Section 97.01-1(A).
Alcohol and drug treatment PNMIs shall maintain
						documentation that each staff member providing such services has received forty
						(40) hours of orientation and training in personal care procedures appropriate
						to residents.
Areas of training must include introduction to chemical
						addictions, assistance in self-administration of medication, infection control,
						bowel and bladder care, nutrition, methods of moving patients, and
						health-oriented record keeping.
Personal care service staff shall adequately perform
						personal care services according to minimum standards set by the Department
						when providing services in community residences for people with mental
						illness.
F.
Other Qualified Child Care Facility
					 Staff
Other qualified child care facility staff are those
						individuals who have appropriate education, training, attributes, and
						experience as approved by the Office of Child and Family Services (OCFS). The
						PNMI shall submit to the OCFS for approval, names and qualifications of
						personnel defined as other qualified child care staff in the format provided by
						that Office.
1. In order to qualify
					 for reimbursement for other qualified child care facility staff, the PNMI shall
					 provide written evidence on file with the provider that other qualified child
					 care facility staff shall meet the standards outlined in the certification
					 requirements established by the OCFS as documented by written evidence on file
					 with that Office.
2. Other
					 qualified child care staff, when performing PNMI reimbursable services, shall
					 receive regular, documented supervision by appropriately licensed or certified
					 staff in accordance with the Rules for Licensure of Residential Child Care
					 Facilities, (or in the case of facilities also licensed by the Office of
					 Behavioral Health, Licensed Alcohol and Drug Counselors).
G.
Other Qualified Licensed Treatment
					 Foster Care Providers
Other qualified licensed treatment foster care providers
						are licensed treatment foster care homes/parents who hold a contract to provide
						treatment foster care services to State agency clients.
H.
Interpreter Services
See Chapter I for provider rules regarding Interpreter
						Services.
I.
Clinical
					 Consultant Services
Clinical consultant services must be provided by
						licensed or certified professionals as described in Chapter II, Section
						97.07-2, of these rules, and working within all State and Federal regulations
						specific to the services provided.
For those facilities covered under Chapter II, Appendix
						B, substance use facilities, clinical consultants may include substance use
						services including methadone maintenance services.