Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 193 - OFFICE OF ADULT MENTAL HEALTH › Chapter 6 - MENTAL HEALTH LICENSING REGULATIONS › COMMUNITY SUPPORT SERVICE STANDARDS

Current through 2024-29, July 17, 2024
These standards, in addition to the core standards, are
				  applied to agencies providing community support services for clients with
				  severe and disabling mental illness, and include case management, outreach,
				  assistance in meeting basic needs, direct skill teaching (activities of daily
				  living, social skills, etc.), assistance, consultation, education, advocacy,
				  and supportive counseling. Community support functions include: developing
				  service agreements, participation in hospital discharge meetings providing
				  personalized support to clients, and participation in crisis intervention and
				  resolution.
Access
CS.1 The agency has policies and procedures governing the
				  establishment of a waiting list which minimally includes the following:
				  prioritizing clients, selecting clients from the wafting list, and referring to
				  other providers.
CS.2 Eligible individuals are informed of their right to
				  receive an Individualized Support Plan and community support services and, when
				  accepted or requested, receive them in a timely fashion.
CS. 2. A. There is documented evidence that clients living in
				  the community who apply and are eligible for services, are assigned a community
				  support worker within three working days of application.
CS. 2. A.1 When community support services cannot be assigned
				  within three working days, the agency shall immediately notify the Commissioner
				  in writing.
CS. 2. B. There is documented evidence that an Individualized
				  Support Plan is developed within 30 days of application.
CS. 2. C. When a hospitalized client requests a community
				  support worker, a worker will be assigned within one working day of receipt of
				  the request from the hospital.
CS. 2. C.1 The agency documents the date and time of the
				  hospital's request;
CS. 2. C.2 The agency documents the date and time the
				  community support worker was assigned.
CS. 2. D. There is documented evidence that individuals who
				  decline the services of a community support worker or Individualized Support
				  Maine Mental Plan are informed that they may apply for these services at any
				  subsequent time.
CS. 2. E. The agency mill. develop a policy and procedure and
				  be able to demonstrate that he screening process for determination of
				  eligibility for services is completed within 30 days of application.
CS.3 There are regular and scheduled outreach services
				  available in the agency's service area.
CS. 3. A Outreach contacts are documented and attempt to
				  address the following:
CS. 3. A. 1 identifying information;
CS. 3. A.2 an informal assessment of the individual's
				  needs;
CS. 3. A.3 the individual's level of commitment to initiate
				  services; and
CS. 3. A.4 an informal plan for engaging the individual
				  further.
Interpretive Guideline for CS.3 through CS.3.A.4
For outreach services in general, informed consent for
				  service provision should obtained when an individual agrees to initiate
				  services. Initiation of service is defined as the point when an individual
				  agrees to have an outreach worker actively pursue services, other than
				  information and referral, on their behalf.
Assessment
CS.4. A comprehensive assessment is conducted by an
				  individual chosen or agreed to by the client, with the client's participation,
				  within 30 days of the client agreeing to initiate services.
CS. 4. A.. The comprehensive assessment minimally addresses
				  the following:
CS. 4. A..1 the client's strengths and weaknesses;
CS. 4. A..2 the client's perception of his or her
				  needs;
CS. 4. A..3 the family/guardian's input and perception of the
				  client's needs when appropriate, and with the client's consent;
CS. 4. A..4 a personal, family, and social history;
CS. 4. A..5 the emotional, psychiatric and psychological
				  strengths and needs of the client;
CS. 4. A..6 a physical health status and history, including
				  current prescribed and over-the-counter medication use and dental needs;
CS. 4. A..7 past and current drug/alcohol use;
CS. 4. A..8 a developmental history;
CS. 4. A..9 possible sources of assistance and support in
				  meeting the needs expressed by the client or legally responsible party,
				  including state -and federal entitlement programs;
CS. 4. A..10 physical and environmental barriers that may
				  impede the client and family's ability to obtain services;
CS. 4. A..11 history of physical and/or sexual abuse;
CS. 4. A..12 the vocational, educational, social, living,
				  leisure/recreation and medical domains; and
CS. 4. A..13 potential need for crisis intervention services;
CS. 4. A..14 housing and financial needs;
CS.4. A.15 the status of the Individualized Support Plan;
CS. 4. A.15.a. in instances in which the Individualized
				  Support Plan is the only service the client is receiving and there is no
				  evidence of other immediately needed services, the worker will complete a
				  preliminary assessment based upon the information in the workers possession
				  and, every 30 days subsequently, update the status of the ISP in a progress
				  note. For these clients, the comprehensive assessment will be completed within
				  30 days of the completion of the ISP or the identification of an immediate
				  service need; and
CS. 4. A..16 the signature of the person who performed the
				  assessment.
Interpretive Guideline for CS.4.A.1 thru CS.4.A.16
The Division of Licensing recognizes that in some cases not
				  all of the information requested in these standards will be able to be
				  obtained. The Division also recognizes that the level of detail required will
				  vary given a variety of factors (the client's level of cooperation, the
				  integrity of the information sources, the length of services or treatment, the
				  condition being addressed, the practitioner's training, etc.). Although the
				  Division will attempt to be sensitive to these factors and flexible in
				  surveying this area, the agency should assure that assessments that do not
				  address all these standards have accompanying documentation that justifies
				  abbreviated or absent information.
CS. 4. B. The agency will establish and adhere to policies
				  and procedures establishing criteria for the performance of the following
				  assessments
CS. 4. B.1 a nutritional assessment;
CS. 4. B.2 a cognitive functioning assessment;
Interpretive Guideline for CS.4.B.2
The client's cognitive functioning assessment should include
				  assessment of the following functions: problem solving, decision making,
				  organization, self-direction, system negotiation skills, concentration, and
				  abstract reasoning. For individuals over 60 years of age, this assessment
				  should also include memory, language, orientation, and visuo-spatial abilities.
CS. 4. B.3 an assessment of the client's capacity to make
				  reasoned decisions; and
CS. 4. B.4 a neurological assessment.
Interpretive Guideline for CS.4.B thru CS.4.B.4
These assessments do not necessarily have to be performed in
				  the agency or by agency staff. the intent of these standards are to assure that
				  the agency has mechanisms by which to evaluate the need for these assessments
				  and to perform or refer for assessment those clients whose symptomatology
				  suggests such need.
CS. 4. C The assessment(s) shall be obtained from the client,
				  legally responsible party, community service agencies, and to the extent
				  possible, from other individuals in the community as authorized by the client
				  or legally responsible party.
CS. 4. D The client record contains a summary evaluation of
				  the data collected in the comprehensive assessment.
CS.5 The agency has a documented policy and procedure on
				  updating assessments that assures that assessments are current and in no case
				  exceed annual updates, Service Planning
CS.6 There is documented evidence that the service planning
				  and revision process involves the client, legally responsible party, and other
				  representatives and professionals whom the client designates.
Interpretive Guideline for CS.6
The client and legally designated guardian shall be fully and
				  actively involved in the development or revision of the service plan, if
				  possible. It the client consents, the client's designated representative e,
				  family members or significant others shall be included in the development and
				  revision of the service plan, unless contraindicated. When these individuals do
				  not attend, their absence is noted. Each agency shall document good faith
				  efforts, including at least 10 days notice of any service planning meeting, to
				  involve guardians, representatives or legally responsible parents. In instances
				  in which the agency is unable to provide 10 days notice, a written
				  justification will be entered in the client's record.
CS.7 A service plan is developed for each client within 30
				  days of initiation of service, with the client and based upon the wants and
				  needs of the client identified in the comprehensive assessment and, if the
				  client has one, the Individualized Support Plan.
CS. 7. A. The service plan minimally contains the
				  following:
CS. 7. A.1 problem statements;
CS. 7. A.2 short- and long-range goals based upon client
				  needs with a projection of when such goals will be attained;
CS. 7. A.3 objectives stated in terms which allow objective
				  measurement of progress;
CS. 7. A.4 multidisciplinary input and specification of
				  treatment responsibilities;
CS. 7. A.5 client input and signature;
CS. 7. A.6 signatures of all people participating in the
				  development of the plan;
CS. 7. A.7 the methods and frequency of treatment,
				  rehabilitation, support;
CS. 7. A.8 a description of any physical handicap and any
				  accommodations necessary to provide the same or equal services and benefits as
				  those afforded non-disabled individuals; and
CS. 7. A.9 criteria for discharge.
CS. 7. B Justification for not addressing problems identified
				  in the assessments is documented in the client record.
Interpretive Guideline for CS.7.B
The intent of this standard is to assure that the clinical
				  staff considers all of the client's identified problems in formulating the
				  service plan. problems that are not reflected on the service plan should have
				  accompanying documentation identifying the rationale for not addressing the
				  problems at this time. This documentation can take many forms including
				  progress notes service plan narratives, etc.
CS.8 The service plait is designed so that the client's
				  progress towards service plan goals can be monitored and evaluated.
Interpretive Guideline for CS.8
Service plans should have measurable goals and some means for
				  reflecting when, or to what degree, a goal has been attained. The organization
				  should also have mechanisms that document monitoring and evaluation of client
				  goals, e.g., quality assessment, treatment plan review documents.
CS.8 The service plan is reviewed at major decision points in
				  each client's treatment course, upon client request, and no less frequently
				  than every 90 days.
Interpretive Guideline for CS.9
Major decision points may include, but are not necessarily
				  limited to the following: when there is a change in the client's condition,
				  when a service appears not to benefit the client, when the client is under- or
				  over- utilizing services.
CS.10 Unmet service needs are documented in the service plan
				  and in Interim plans subsequent to the service planning process.
Interpretive Guideline for CS.10
If at the time of or subsequent to the service planning
				  meeting, team members know, on the basis of reliable information, that the
				  needed services are unavailable, they shall note them as "unmet service needs"
				  on the service plan and develop and interim plan based upon available services
				  that meet, as nearly as possible, the actual needs of the client. The
				  organization should also document notification of the organization's leaders
				  and the commissioner regarding the unavailability of service that is causing
				  the unmet need.
CS.11 The agency has a policy and procedure for providing
				  clients with a copy of their service plan within one week following its
				  formulation, review or revision and notification of client recourse should they
				  disagree with any aspect of the plan.
CS. 11. A. There are no instances in which the agency fails
				  to provide a copy of the client's service plan and/or notify them of recourse
				  should they disagree.
Service Delivery
CS.12 Community support workers assist clients in negotiating
				  linkages with service providers as evidenced by documentation that reflects
				  each contact and the delivery of those services deemed appropriate in the
				  client's service and support plans.
Discharge Planning
CS.13 Each client record contains documentation of current
				  discharge or termination planning.
CS.14 The agency has discharge planning policies and
				  procedures.
CS. 14. A The agency has a policy and procedure for
				  determining when a client is considered 'inactive'.
CS. 14. A.1 The inactive status policy and procedure notes
				  what documentation is kept on the client during inactive status.
CS. 14. A.2 The inactive status policy and procedure notes
				  the duration of inactive status before the case is considered closed.
CS.15 A discharge summary is entered in the client record
				  within 15 days of discharge or on the 90th day of inactive status and includes
				  the client's course of treatment and ongoing needs at discharge.
CS. 15. A. Each discharge summary minimally addresses, WU
				  neat not be limited to the following:
CS. 15. A.1. the reasons for termination of service;
CS. 15. A.2. the final assessment, including die general
				  observations and significant findings of the client's condition initially,
				  while services are being provided and at discharge;
CS. 15. A.3. the course and progress of the client with
				  regard to each identified problem; and
CS. 15. A.4. the recommendations and arrangements for further
				  continued service needs.
Interpretive Guideline for CS.15
For clients on inactive status, a discharge summary should be
				  completed no later that 90 days following placement on inactive status or
				  earlier given the following conditions:
1. another agency submits a request for the client's
				  discharge summary prior to the 90th day of inactive status;
2. agency policy requires that discharge summary be completed
				  earlier than the 90th day of inactive status; and
3. practitioners who are leaving agency employment must
				  complete discharge summaries on all of their inactive status clients regardless
				  of time frame.
CS.16 The agency has policies and procedures that specify
				  under what conditions services may be discontinued or interrupted which
				  minimally include how and when, the client is notified.
CS. 16. A. For agencies serving DMHMR class members, the
				  agency shall first obtain prior written approval for discontinuing or
				  interrupting services from the Department.
CS. 16. B For agencies serving DMHMR class members, the
				  agency shall give thirty days advance written notice to the client and the
				  client's guardian. If the client poses a threat of imminent harm to persons
				  employed or served by the agency, the agency shall give notice that is
				  reasonable under the, circumstances.
CS. 16. C. For agencies serving DMHMR class members, the
				  agency shall give such notice as may be required by law or regulation.
CS. 16. D For agencies serving DMHMR class members, the
				  agency shall assist the client in obtaining the services from another agency.
CS. 16. E For agencies serving DMHMR class members, the
				  agency shall provide documented evidence in the client record of compliance
				  with these standards, through letters, progress notes, phone logs, and/or
				  facsimile.
CS.17 Applicants who are not eligible for services will be
				  referred to appropriate services, if required, available and desired.
CS. 17. A. The agency has a policy and procedure on referral
				  and/or transfers of individuals deemed inappropriate for services offered by
				  the agency that minimally includes communicating the rationale for the
				  referral/transfer to the applicant and providing them with a list of
				  alternative service providers and advocacy services.
CS. 17. B. The agency provides and documents other assistance
				  as required to assist the individual to obtain/access the services to which
				  they are referring him/her.
Health
CS.18 If food services are provided, the facilities for the
				  preparation and serving of food shall be inspected and approved by the
				  Department of Human Services.
CS. 18. A. If food is either prepared or served at the
				  facility, then the agency shall either obtain a DHS Eating Establishment
				  license or show written evidence from DHS indicating that they do not need such
				  a license.
CS. 18. B. When the agency requires a DHS license, the
				  agency's Eating Establishment license is current.
CS.19 The agency shall have methods for obtaining on- or
				  off-site medical services for all clients.
CS. 19. A. The agency defines in policy and procedure those
				  medical services delivered on-site. For those medical services not provided
				  on-site, letters of agreement and/or procedures for accessing medical service
				  provider(s) are in effect.
Human Resource Management
CS.20 There is documented evidence that community support
				  workers are licensed or certified to deliver mental health services as approved
				  by the Division.
CS.21 Community support workers shall have a maximum of 40
				  clients in their caseload.
CS. 21. A. For purposes of this standard, individual clients
				  who present a multiplicity of needs, who has: recently required aids
				  intervention and resolution services or who have a need for especially intense
				  community support shall, for purposes of computing the above ratio, be counted
				  as 2.5 clients.
CS. 21. 1B. In instances in which the agency has compelling
				  reasons for not meeting this standard, those reasons will be documented as well
				  as efforts being taken to achieve compliance with the standard.