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-85 - MaineMOM Services and Reimbursement › Subsection 144-101-II-85.09 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
85.09-1
Qualified Professional Staff are:
Physical Therapist
Physical Therapy Assistant
All professional staff must be conditionally,
						temporarily, or fully licensed as documented by written evidence from the
						appropriate governing body. All professional staff must provide services only
						to the extent permitted by licensure. A Physical Therapist may be self-employed
						or employed by an agency or business. Agencies or businesses may enroll as a
						provider of service and bill directly for services provided by qualified staff.
						A Physical Therapy Assistant may not enroll as an independent billing
						provider.
85.09-2
Member Records
Providers must maintain a specific record for each
						member, which shall include, but not necessarily be limited to:
1. Member's name, address, birthdate, and
					 MaineCare ID number
2. The member's
					 social and medical history and medical diagnoses indicating the medical
					 necessity of the service or services
3. A personalized plan of service including
					 (at a minimum):
A. Type of physical therapy
					 needed;
B. How the service can best
					 be delivered, and by whom the service shall be delivered;
C. Frequency of services and expected
					 duration of services;
D. Long and
					 short range goals;
E. Plans for
					 coordination with other health service agencies for the delivery of
					 services;
F. Medical supplies for
					 which a Practitioner of the Healing Arts' order is necessary; and
G. Practitioner of the Healing Arts' orders
					 including, for adults, their documentation of the member's rehabilitation
					 potential.
The physician or primary care provider must review, sign
						and date the member's plan of care at least once every three (3) months for
						adult members (age twenty-one (21) and over). The plan of care must be kept in
						the member's record and is subject to Departmental review along with the
						contents of the member's record.
4. Written progress notes each day the member
					 is seen (also referred to as the treatment or session note) shall contain:
A. Identification of the nature, date, and
					 provider of any service given;
B.
					 The start time and stop time of the service, indicating the total time spent
					 delivering the service;
C. Any
					 progress toward the achievement of established long and short range
					 goals;
D. The signature of the
					 service provider for each service provided; and
E. A full account of any unusual condition or
					 unexpected event, including the date and time when it was observed and the name
					 of the observer.
Entries are required for each service billed. When the
						services delivered vary from the plan of care, entries in the member's record
						must justify why more, less, or different care than that specified in the plan
						of care was provided.