Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 118 - OFFICE OF SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES (SAMHS) › Chapter 5 - REGULATIONS FOR LICENSING AND CERTIFYING OF SUBSTANCE ABUSE TREATMENT PROGRAMS › Section 118-5-16 - Private Non-medical Institutions (PNMI)

Current through 2024-29, July 17, 2024
16.1.
Provider agreements.
All
				PNMIs must have a provider agreement that encompasses the MaineCare Provider
				Supplier Agreement on file with the Department of Health and Human Services,
				Division of Licensing and Regulatory Services. Providers must also contract
				with the department and satisfactorily meet all contract and provider agreement
				provisions.
16.2.
Compliance
				with regulations.
A PNMI providing substance abuse services shall comply
				with all portions of these regulations in Section 16 (Substance Abuse Treatment
				Services) pertaining to the component, module, substance abuse treatment
				services, and sites offered by the PNMI.
16.3.
Coordination of PNMI
				services.
It is the responsibility of the PNMI provider to coordinate
				PNMI services with other "in-home" services to address the full range of member
				needs. Other MaineCare covered services shall not duplicate PNMI services
				included in the facility's PNMI rate. Services that are part of the PNMI rate
				may not be billed to MaineCare separately by other providers. For example, if
				the PNMI provides personal care services, and a member receives Home and
				Community Based Waiver Services, the personal care services shall be delivered
				by the PNMI provider and not by a certified nursing assistant (CNA), home
				health aide (HHA), or personal care assistant (PCA) as otherwise
				allowed.
16.4.
Personal care
				staff and services.
PNMIs approved and funded by OSA in
				licensed/certified facilities may also provide personal care services necessary
				for the promotion of ongoing treatment and recovery.
16.4.1. The personal care services provided
				by the PNMI 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 client's family as described in the MaineCare Benefits Manual,
				Chapter II, Section 97.01-6 or the pertinent Appendix of the MaineCare Benefits
				Manual, Chapter III, Principles of Reimbursement.
16.4.3.1. assistance or supervision of
				activities of daily living that could include bathing, dressing, eating,
				toileting, ambulation, personal hygiene activities, grooming, and the
				performance of incidental household tasks essential to the activities of daily
				living and to the maintenance of the member's health and safety within the
				substance abuse treatment PNMI;
16.4.3.2. supervision of or assistance with
				administration of physician ordered medication;
16.4.3.3. personal supervision or being aware
				of the member's general whereabouts, observing or monitoring the member while
				on the premises to ensure their health and safety, reminding the member to
				carry out activities of daily living, and assisting the member to carry out
				activities of daily living, and assisting the member in adjusting to the group
				living facility;
16.4.3.4.
				arranging transportation and making phone calls for medical or treatment
				appointments as recommended by medical providers, or as indicated in the
				member's plan of care;
16.4.3.5.
				observing and monitoring clients and reporting changes in the client's normal
				appearance, behavior, or state of health to medical providers or supervisory
				personnel as appropriate;
16.4.3.6.
				arranging or providing motivational, diversionary, and behavioral activities
				which focus on social interaction to reduce isolation or withdrawal and to
				enhance communication and social skills necessary for ongoing treatment and
				recovery, as described in the member's plan of care;
16.4.3.7. monitoring and supervising client's
				participation in the treatment; and
16.4.3.8. psychosocial services including
				assisting clients to adjust to the substance abuse treatment PNMI, to live as
				independently as possible, to cope with personal problems during periods of
				stress, to accept and adjust to their personal life situations, to accept and
				cope with their chemical addictions and to decrease unhealthy behaviors leading
				to possible relapse into active addiction, in addition to providing services
				and a supportive environment which promotes feelings of safety and freedom from
				danger, fear or anxiety as well as services that assist the client to manage
				mental health symptoms and behaviors related to co-occurring disorders
				.