reglab/statecodes huggingface dataset:
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 105 - CATASTROPHIC ILLNESS PROGRAM

Current through 2024-29, July 17, 2024
SUMMARY STATEMENT: The amendment to the rule reflects recent
				statutory changes in the Catastrophic Illness Program that terminates hospital
				services coverage for eligible recipients on or after May 1, 1984.
STATE OF MAINE
MEDICAL ASSISTANCE PROGRAM (MEDICAID OR TITLE XIX) AND
				CATASTROPHIC ILLNESS PROGRAM
MEDICAID PROGRAM
Services Covered
Categorically
Needy (MM)
Medically
Needy (MI)
Catastrophic
Illness Program (CI)
Ambulance Services
X
X
X*1
Audiology Services
X*2
X*2
0
Chiropractic Services
X
X
0
Dental Services
X*3
X*3
X*4
Family Planning Services
X
X
0
Hearing Aids and Services
X*2
X*2
0
Home Health Services
X
X
0
Hospital (Inpatient/Outpatient)
X
X
X*5 *9
Intermediate Care Facility Services
X
X
0
Laboratory and X-ray Services
X
X
X
Medical Supplies and Equipment
X
X
X
Mental Health Clinic Services
X
X
0
Opticians Services
X*6
X*6
0
Optometrist Services
X*6
X*6
0
Pharmacy Services
X
X
X
Physical Therapy Services
X
X
X
Physician Services
X
X
X*7
Podiatrist Services
X
X
0
Psychological Services
X
0
0
Certified Rural Health Clinic Services
X
X
0
Skilled Nursing Facility Services
X
X
X*8
Speech Pathology Services
X
X
0
X-services covered with limitations as noted and described in
				the Maine Medical Assistance Manual 0-Services not covered.
__________________________________________________________________________________________
*1 = Ambulance services covered only to the "nearest" hospital
				or medical facility which can provide acute care needed.
*2 = Hearing Aids and exams for fitting them covered only for
				persons under 21 included in the EPSDT Program.
*3 = Dental Services covered only for persons under 21 included
				in the EPSDT Program, except for acute care related to traumatic injury and
				certain oral surgical and related medical procedures not involving the
				dentition and gingiva.
*4 = Catastrophic Illness Program recipients are covered for
				only acute dental care related to a traumatic injury and certain oral surgical
				and related medical procedures not involving the dentition and gingiva.
				(Effective 7/13/82)
*5 = The term hospital shall include an accredited Christian
				Science sanatorium instead of a medical hospital. (Currently the nearest
				facility for Christian Scientists is in Boston, so arrangement would need to be
				processed under the provision for out-of-state services).
*6 = Eyeglasses covered only for persons under 21 included in
				the EPSDT Program, except for glasses following eye surgery.
*7 = Psychiatric services are not covered.
*8 = SNF Services limited to 60 days per year, must be admitted
				within 7 days following no less than 5 days of hospitalization.
*9 = Effective on and after May 1, 1984. inpatient hospital and
				outpatient hospital services are not covered by the Catastrophic Illness
				Program.
STATUTORY AUTHORITY:
				   22 M.R.S.A.
				  §3173
P.L. 1984 Chap. 824, Part X
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 109 - QUALITY OVERSIGHT FOR COMMERCIAL HMOs › Section 144-109-1.01 - INTRODUCTION

Current through 2024-29, July 17, 2024
These regulations are promulgated by the Department of Human
				  Services pursuant to Title
				   22 M.R.S.A.,
				  Section42 and establish standards for
				  assuring the quality of care provided by commercial health maintenance
				  organizations pursuant to Chapter 56 of Title 24-A M.R.S.A. Nothing in these
				  regulations may be interpreted to create or enlarge a cause of action in favor
				  of a member or other third party against an HMO or provider.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 109 - QUALITY OVERSIGHT FOR COMMERCIAL HMOs › Section 144-109-1.03 - Quality Management Program

Current through 2024-29, July 17, 2024
The HMO shall have an ongoing internal Quality Management
				  Program to monitor and evaluate its health care services. The HMO shall have a
				  written description of its Quality Management Program containing all of the
				  required elements described in this section.
1.03-1 Structure and Process
The QMP structure and process must include the following
				  components.
A. The HMO shall establish
				goals and objectives for its QMP.
B. The HMO shall describe the scope of its
				QMP. The scope of the QMP shall:
1. be comprehensive, addressing both quality of care and the
				  quality of service; and
2. provide for the review of the entire range of care
				  provided by the HMO and assure that all demographic groups, care settings, and
				  types of services relevant to the HMO's services are included in the scope of
				  review. For purposes of this subsection, "demographic groups" include groups
				  broken down by age, race, ethnicity, gender, geographic region, and urban or
				  rural setting. The provisions of this subsection are not intended to require
				  additional studies by an HMO, but rather that over time the studies conducted
				  by an HMO should address all elements of this subsection.
C. The HMO shall develop annually a work plan
				for its QMP. The HMO's governing body shall review and approve the work plan.
				The work plan shall include a detailed set of QMP goals and objectives for the
				coming year, activities planned for that year, a timetable for implementation
				and accomplishment, an identified party or parties responsible for
				accomplishing each goal and objective, and planned monitoring of previously
				identified issues.
D. The HMO shall
				ensure that the QMP is subject to the review and approval of the governing
				body.
E. The HMO shall designate a
				physician to provide medical direction to the QMP. The physician shall be
				substantially involved in the implementation of the QMP.
F. The HMO shall establish a Quality
				Management (QM) committee with clear lines of authority over the Quality
				Management Programand that is accountable to the governing body.
G. To the extent necessary to meet the
				standards contained in this rule, the HMO shall devote the necessary and
				appropriate personnel, data and analytic resources. The HMO shall ensure that
				QM activities are completed in a timely and competent
				manner.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 109 - QUALITY OVERSIGHT FOR COMMERCIAL HMOs › Section 144-109-1.04 - Certificate of Authority Review

Current through 2024-29, July 17, 2024
1.04-1 Document
				Submittal
An applicant for a Certificate of Authority shall submit
				  documentation consistent with the requirements of Chapter 850(6) or the
				  following documentation:
A. A written
				description of its QMP including:
1. a
				timeline for implementation;
2. an
				organizational chart or charts;
3.
				a job description and the credentials of the senior executive and other
				principal staff responsible for quality management activities;
4. a job description and the credentials of
				the applicant's medical director;
5. the job description and the credentials of
				the members of the QMP committee;
6. a description of the QM committee function
				and plan for ongoing operation;
7.
				a description of the resources that will be devoted to QM activities;
8. a description of the system for peer
				review activities;
9. a description
				of the applicant's plan for developing and disseminating clinical
				guidelines;
10. a description of
				the applicant's plan for conducting quality management studies;
11. a description of the applicant's plan for
				conducting intervention and assessment when the quality management studies
				identify opportunities for improvement;
12. a description of the applicant's plan for
				monitoring and evaluating the continuity of care and utilization;
13. a description of the applicant's plan for
				evaluating the performance of its QMP; and
14. such other information as may be
				reasonably required by the Department.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 109 - QUALITY OVERSIGHT FOR COMMERCIAL HMOs › Section 144-109-1.05 - Periodic examination

Current through 2024-29, July 17, 2024
The Department shall conduct a periodic examination of the
				  HMO as often as the Commissioner deems necessary for the protection of the
				  interests of the people of the State, but not less frequently than once every
				  three years. The periodic examination shall include a desk audit and onsite
				  review. No notice requirements pertaining to a scheduled examination shall be
				  interpreted to preclude the Department from conducting an onsite examination
				  without notice to the HMO. The Department shall not conduct a scheduled
				  periodic examination of an HMO before three years following the date of the
				  issuance of the HMO's first license.
As provided in this section, a periodic examination may be
				  coordinated with an accreditation survey by a DHS approved national accrediting
				  organization. An HMO accredited by, or seeking accreditation by, a nationally
				  recognized accrediting organization may apply for Department approval of the
				  accrediting organization. An application must include a copy of the accrediting
				  organization's standards for the Department's consideration along with a
				  statement identifying with specificity any differences between those standards
				  and the requirements of this rule. Should the Department approve the HMO's
				  application the periodic examination review process will be coordinated with
				  the Department approved nationally recognized accrediting organization as
				  described in this Section. In the event an HMO does not seek approval of a
				  nationally recognized accrediting organization and the HMO is accredited by or
				  seeking accreditation by NCQA, NCQA shall be considered the Department approved
				  national accrediting organization.
1.05-1 Coordination with the Department
				Approved National Accrediting Organization
If an HMO is subject to review by a Department approved
				  national accrediting organization, the Department shall coordinate its periodic
				  examination of the HMO with the Department approved national accrediting
				  organization's accreditation review process. In order for the Department to
				  coordinate the review process, the following provisions shall apply:
A. Within ten (10) working days after
				receiving its Department approved accrediting organization accreditation survey
				report, the HMO shall submit to the Department the following documentation:
1. the documentation required under Section
				1.05-7, or such portion of that documentation as the Department may require;
				and
2. the final accreditation
				survey report of the Department approved accrediting organization, as required
				under Section 1.05-2.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 109 - QUALITY OVERSIGHT FOR COMMERCIAL HMOs › Section 144-109-1.06 - Annual Statement

Current through 2024-29, July 17, 2024
The HMO shall submit an annual statement to the Commissioner
				  on March 1 of each year, except that an HMO that has been licensed less than
				  six months as of March 1 shall not be required to report until the following
				  year.
1.06-1 Specifications for the
				Annual Statement
The annual statement shall be in a format and meeting
				  specifications acceptable to the Commissioner and shall contain the following
				  information:
A. QMP Description. The
				HMO's most recently approved written description of its QMP;
B. Work Plan. The HMO's most recently
				approved work plan;
C. Evaluation.
				The HMO's most recently approved annual QMP evaluation report;
D. HEDIS Effectiveness of Care Measures. The
				HMO's HEDIS Effectiveness of Care Measures for the most recent NCQA reporting
				period. Beginning two years after the effective date of this rule or approval
				of the HMO's certificate of authority application, whichever is later, the
				Effectiveness of Care Measures shall have been audited by an NCQA-certified
				auditor or other auditor approved by the Department; and
E. Credentialing Activity. For the most
				recent calendar year, the HMO shall submit the following information relating
				to practitioner credentialing, broken down by type and specialty:
1. number of practitioners reviewed for
				credentialing;
2. number of
				practitioners given credentials;
3.
				number of practitioners denied credentials and why;
4. number of practitioners given provisional
				credentials;
5. average duration of
				provisional credentials prior to full credential decision;
6. identity and number of practitioners given
				provisional credentials but not given full credentials and why;
7. number of practitioners reviewed for
				recredentialing;
8. identity and
				number of practitioners denied recredentialing, and why; and
9. identity and number of practitioners with
				whom affiliation was terminated outside of periodic recredentialing process,
				and why.
F.
				Certification
Certification by the governing body or a member of senior HMO
				  management that the reports submitted pursuant to this section are accurate, to
				  the knowledge and best ability of that body or
				  person.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-2 - Obtaining a License

Current through 2024-29, July 17, 2024
2.A.
Requirements
2.A.1. No person or
				entity shall operate a nursing facility without a license from the Department
				in force, authorizing such operation. (Title 22, Section 1811 )
2.A.2. The person or entity applying for the
				license shall be responsible for complying with Maine Statutes and all rules
				and regulations adopted pursuant thereto. (Title 22, Section 1811 )
2.A.3. Reimbursement shall not be accepted,
				by any person, for rendering nursing facility care for even one person not a
				relative within the third degree of kinship, without such person having first
				secured a license in force, authorizing such operation in accordance with these
				regulations.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-5 - Facility Policies

Current through 2024-29, July 17, 2024
5.A.
Professional Policy Group
5.A.1.
Requirements
Each facility shall have written policies which govern all
				  areas of services provided and are developed with the advice of, and with
				  provisions for, annual review by a group of professional personnel including
				  the administrator, Director of Nurses, a physician, a registered pharmacist,
				  and such other professional personnel as necessary.
5.A.2.
Meetings
The professional policy group shall meet as necessary, but at
				  least annually, to review written policies and reports of the Quality Assurance
				  and other Committees. All members of the group should be present or have input
				  and minutes of meetings shall be recorded and reflect the activities.
5.A.3. The professional policy
				group meetings may be incorporated within the Quality Assurance
				Committee.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-7 - Residents' Property and Finances

Current through 2024-29, July 17, 2024
7.A.
Authority and Responsibility
7.A.1.
Presence of Resident
The admission of a resident to a facility shall not confer on
				  such facility or its owner, administrator, employees or representatives any
				  authority to manage, use or dispose of any property of such resident, nor shall
				  such admission or presence confer on any of the aforementioned persons any
				  authority or responsibility for the personal affairs of the resident, except
				  insofar as may be necessary for the safe and orderly management of the licensed
				  facility.
7.A.2.
Guardian, Trustee or Conservator
No facility, and no owner, administrator, employee or
				  representative thereof or their relative shall act as guardian, trustee or
				  conservator for any resident of such facility or any of such resident's
				  property. Exceptions to this requirement may be considered by the Department
				  for residents who are relatives of the owner, administrator, employee or
				  representative of the licensed facility or their spouse within the third degree
				  of kinship.
7.A.3.
Safekeeping
A licensed facility shall provide for the safekeeping of
				  personal effects, funds, and other property of the resident. For the protection
				  of valuables, or in order to avoid unreasonable responsibility thereof, the
				  facility may require that they be excluded or removed from the facility and
				  kept at some place not subject to the control of the facility. Any removal or
				  exclusion shall be done only after reasonable notice is given to the resident
				  or his/her guardian.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-8 - Personnel

Current through 2024-29, July 17, 2024
8.A.
Personnel Policies
The facility shall have policies that address all personnel
				  practices.
8.B.
Staff
				Qualifications
8.B.1. The facility
				must employ, on a full time, part time, or consultant basis those persons
				necessary to carry out the provisions of these regulations.
8.B.2. Staff must be licensed, certified, or
				registered in accordance with applicable State laws.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-9 - Resident Care Staffing

Current through 2024-29, July 17, 2024
9.A.
Minimum
				Nursing Staff Requirements
The following minimum nursing staff requirements shall be
				  met:
9.A.1.
Director of
				Nursing
a. In each licensed nursing
				facility there shall be a Registered Professional Nurse employed full-time who
				shall be responsible for the direction of all nursing services delivered in the
				facility.
b. The Director of
				Nursing must be qualified by education, training and experience in both
				Gerontology and nursing administration.
c. If the Director of Nursing is functioning
				as a Temporary Administrator, a nurse shall be appointed to act as the Director
				of Nursing during that period of time.
d. Lines of responsibility shall be clearly
				established in writing and shall be made known to all nursing staff and other
				appropriate personnel.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-12 - Pre-Admission Screening, Comprehensive Assessments and Plans of Care

Current through 2024-29, July 17, 2024
12.A.
Pre-Admission Screening
Facilities may not admit any resident who has not had a
				  pre-admission screening for mental illness and/or mental retardation.
12.A.1.
Definition
: For the
				purposes of this Chapter:
a. Mental Illness
An individual is considered to be mentally ill if the
				  individual has a primary or secondary diagnosis of a mental disorder as defined
				  in the
American Psychiatric Association Diagnostic and Statistical
				  Manual
(DSM-III 1R), 4th edition, and which
				  does not include dementia.
b. Mental Retardation
An individual is considered to be "mentally retarded" if
				  there is "significantly subaverage general intellectual functioning existing
				  concurrently with deficits in adaptive behavior and manifested during the
				  developmental period".
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-13 - Nursing Services

Current through 2024-29, July 17, 2024
13.A.
Quality
				of Care
Each resident must receive, and the facility must provide,
				  the necessary care and services to attain or maintain the highest practicable
				  physical, mental, and psychosocial well-being, in accordance with the
				  comprehensive assessment and plan of care for each resident that includes
				  measurable objectives and timetables to meet a resident's medical, nursing and
				  psychosocial needs that are identified in the comprehensive assessment that is
				  in conformance with the current standards of the Gerontological Nursing
				  Practice of the American Nurses Association.
13.A.1.
Activities of Daily Living
				(ADL)
Based on the comprehensive assessment of a resident, the
				  facility must ensure that:
a. A
				resident's abilities in Activities of Daily Living do not diminish unless
				circumstances of the resident's clinical condition demonstrate the diminution
				was unavoidable. This includes the resident's ability to:
1. bathe, dress, and groom;
2. transfer and ambulate;
3. toilet;
4. eat;
5. use speech, language or other functional
				communication systems; and
6. bed
				mobility.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-15 - Activities

Current through 2024-29, July 17, 2024
15.A. The facility must provide for an
				ongoing program of activities designed to meet the interests and the physical,
				mental and psychosocial well-being of each resident in accordance with the
				comprehensive assessment.
15.A.1.
Activities Coordinator
The Activities Coordinator shall be qualified by training or
				  experience as evidenced by:
a. Having
				completed, or is currently enrolled in a training course approved by the
				Department of Education; or
b.
				Having completed an approved course prior to July 1, 1994; or
c. Is a registered occupational therapist or
				an occupational therapy assistant; or
d. Is a qualified therapeutic recreation
				specialist.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-17 - Pharmaceutical Services

Current through 2024-29, July 17, 2024
17.A.
Pharmaceutical Services
Pharmaceutical services shall be conducted in accordance with
				  currently accepted professional standards of practice and in accordance with
				  all applicable laws and regulations.
Facilities shall develop policies and procedures for the
				  prescribing (including standing orders), obtaining, dispensing, administering,
				  controlling, storing, and disposing of all drugs and biologicals with the
				  advice of a staff pharmacist or a consultant pharmacist and approved by the
				  professional policy group.
17.B.
Definitions
17.B.1.
Adverse Drug
				Reaction
- is any undesired or unintended effect of a medication, to
				include:
a. Hypersensitivity or allergic
				reactions: a reaction due to a patient's immune response,
b. Idiosyncrasy: a susceptibility or
				sensitivity peculiar to a rare phenotype (extreme sensitivity to low
				doses),
c. Toxicity: a "poisoning"
				due to overdosage or accumulation,
d. Side Effect: an undesired pharmacologic
				effect which is predictable.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-18 - Dietary Services

Current through 2024-29, July 17, 2024
18.A.
Policies and Procedures
18.A.1.
				Dietetic services shall be described in the facility's policy and procedure
				manual with at least the following:
a.
				Organization and dietetic services offered;
b. Personnel management;
c. Staffing and budgeting;
d. orientation and in-service
				education;
e. Menu
				planning;
f. Therapeutic
				diets;
g. Resident clinical
				nutritional care;
h. Purchasing,
				receiving, and storing of food and supplies;
i. Food preparation and service;
j. Meal and nourishment service;
k. Safety, sanitation, and infection
				control;
l. Time parameters for
				storage of opened or leftover foods; and
m. Disaster feeding plan.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-19 - Records

Current through 2024-29, July 17, 2024
19.A.
Clinical Records
The facility must maintain clinical records on each resident
				  in accordance with accepted professional standards and practices.
19.A.1. All current clinical information
				pertaining to a resident's stay shall be available at the nurses station.
a. The resident's records must be kept in the
				facility at all times. The record may be in paper or electronic
				format.
b. All recording is done in
				the facility.
c. The records are
				immediately available to resident care personnel.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Section 144-110-23 - Alzheimer's/Dementia Care Units

Current through 2024-29, July 17, 2024
The purpose of this Section is to establish standards for
				  Alzheimer's/Dementia Care Units and to establish criteria for the Units, which
				  provide Alzheimer's/Dementia patients or residents with a positive quality of
				  life, consumer protection and maximum individualized care that promotes rights,
				  dignity, comfort and independence in the least restrictive environment.
Adherence to these rules does not exempt the facility from
				  complying with its licensing or registration rules. These rules are in addition
				  to the facility's licensing rules.
23.A.
Definitions
For the purposes of this Chapter, the following words will
				  have the meanings indicated:
23.A.1.
"Alzheimer's/Dementia Care Unit"
means a unit that provides
				care/services in a designated, separated area for patients and residents with
				Alzheimer's Disease or other dementia that is able to be locked, segregated or
				secured to limit access by a resident outside the designated or separated
				area.
23.A.2.
"Dementia"
means a clinical syndrome characterized by a decline in
				mental function of long duration in an alert individual. Symptoms of dementia
				include memory loss and the loss or diminution of other cognitive abilities,
				such as learning ability, judgment, comprehension, attention and orientation to
				time and place and to oneself. Dementia can be caused by such diseases as:
				Alzheimer's Disease, Pick's Disease, Amyotrophic Lateral Sclerosis (ALS),
				Parkinson's and Huntington's Disease, Creutzfeldt-Jakob Disease, multi-infarct
				dementia, etc.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Addendum - Addendum

Current through 2024-29, July 17, 2024
References:
1.
				Statutory authority for these regulations is found under the following Titles
				in the Maine Revised Statutes:
STATUTORY AUTHORITY:
Title 1, Chapter 13,
				  Section 401, 402, 407, 408; Title 22, Chapter 1, Section 3, 6, 42, 47; Chapter
				  405, Sections 1811-1818, 1820, 1822, 1824-1830; Chapter 958-A, Sections
				  3477-3479; Chapter 1666, Sections 7921-7925; Chapter 1666A, Sections 7931-7938;
				  Chapter 1666B, Sections 7941-7949; Chapter 1678, Sections 8551-8552; Title 32,
				  Chapter 2, Sections 61, 7905; Title 5, Chapter 375, Subchapter 1 1-A, Section
				  1;
				  22
				  MRSA §802, sub §4 Section 2;
				  22
				  MRSA §802, sub §5; Title 22,
				  §7944.
2. Additional
				references of use are:
Medicare Medicaid: Requirements for Long Term Care
				  Facilities
; 42 Code of Federal Regulations, Parts 420, 431, 442, 447,
				  483, 488, 489
The Department of Human Services, Bureau of Medical
				  Services,
Maine Medical Assistance Manual
; Chapter I, Section
				  1 and Chapter II, Section 67
State of Maine Department of Human Services
				  Principles of Reimbursement for Nursing Facilities
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 110 - REGULATIONS GOVERNING THE LICENSING AND FUNCTIONING OF SKILLED NURSING FACILITIES AND NURSING FACILITIES › Attachment B - DESCRIPTION OF COMMONLY REQUESTED ITEMS AND SERVICES THAT ARE NOT COVERED BY THE FACILITY'S DAILY RATE

Current through 2024-29, July 17, 2024
Certain items and services are generally not covered by the
				  Facility's daily rate. It is not possible to make a complete list of those
				  items and services, but the list below does contain those most commonly needed
				  or requested.
The Resident will be billed separately by the Facility or by
				  third parties providing the item or service. The cost or part of the cost for
				  some items and services may be picked up by Medicaid, Medicare or by the
				  Resident's other health insurance, if any.
The Resident should also refer to Attachment A to
							 determine which of those items and services are covered by the Facility's daily
							 rate and which are not.
Item or Service
Ambulance services
Audiology services
Dental services
Laboratory services
Occupational therapy
Optometry services
Pharmacy services
Physical therapy
Physicians' services
Podiatry services
Speech and language therapy
Radiology services
Respiratory therapy
Special care services, such as privately hired
							 nurses or aides
Other
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 111 - TEMPORARY NURSE AGENCY LICENSING RULE › Section 144-111-1 - PURPOSE AND SCOPE

Current through 2024-29, July 17, 2024
A.
Purpose
This rule governs the registration of Temporary Nurse
				  Agencies (TNA) in Maine, in accordance with 22 MRS Chapters 417 and 417-A. This
				  rule operationalizes and clarifies the content of Maine statutes regarding the
				  registration of TNAs, the operational requirements for these agencies, and
				  enforcement actions allowed by law.
B.
Scope
This rule applies to all TNAs operating within the State of
				  Maine, whether located within the state or located elsewhere, and placing
				  nursing staff, certified nursing assistants, and other qualified staff in
				  health care facilities and/or health care settings within the
				  state.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 111 - TEMPORARY NURSE AGENCY LICENSING RULE › Section 144-111-3 - REGISTRATION AND FEES

Current through 2024-29, July 17, 2024
A.
Initial
				registration.
A proposed TNA must register with the Department prior to
				beginning operations in the State of Maine.
1.
				This registration includes submitting a completed application and the required
				fee as established by 22 MRS § 2131.
2. Registrations will be valid for one
				year.
3. The TNA must designate an
				individual to be the day-to-day person in charge who will be the point person
				for communication with the Department and provide electronic contact
				information for that individual on the application.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 111 - TEMPORARY NURSE AGENCY LICENSING RULE › Section 144-111-4 - QUALITY ASSURANCE

Current through 2024-29, July 17, 2024
A.
Employee
				quality assurance.
1. A TNA shall
				ensure that each employee the agency assigns or refers to a health care
				facility or setting for a position meets the state and federal qualification
				requirements for that position and has the appropriate work experience for that
				position.
2. A TNA must maintain a
				record for each employee that includes documentation of the following:
a. The employee's credentials, including
				evidence of licensure, if applicable;
b. Required immunizations in accordance with
				10-144 CMR Chapter 264, Immunization Requirements for Healthcare
				Workers;
c. Orientation;
d. In-service education;
e. Completion of required training or
				education; and
f. Contact
				information (i.e.: current phone number and email address).
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 111 - TEMPORARY NURSE AGENCY LICENSING RULE › Section 144-111-5 - ANNUAL REPORTING REQUIREMENTS

Current through 2024-29, July 17, 2024
A.
Annual
				reporting
. By July 31st of each year, a TNA must provide an annual
				report to the Department covering the preceding reporting period, in a format
				determined by the Department. The report must include the following:
1. The number of total employees placed, the
				health care settings and facilities into which they were placed, the average
				duration of the placements, and the state of licensure for those
				employees;
2. The total and average
				amounts charged during each quarter of the reporting period to a health care
				facility or setting for each category of health care employee providing
				services to the health care facility or setting;
3. The total and average amounts of wages
				paid during each quarter of the reporting period to health care employees for
				each category of health care employee;
4. The total and average amounts of stipends
				paid during each quarter of the reporting period to health care employees for
				each category of health care employee;
5. Documentation that each employee
				contracted to a health care facility or setting during the reporting period had
				a current, unrestricted license or certification in good standing and met the
				training and continuing education standards required by state and federal law
				for the position with the health care facility or setting throughout the
				entirety of the reporting period; and
6. Documentation that the TNA had
				successfully completed all background checks required by federal and state law
				relating to the health care position and health care facility or setting in
				which the employee was placed during the reporting period, for each employee
				contracted to a health care facility or setting.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 111 - TEMPORARY NURSE AGENCY LICENSING RULE › Section 144-111-6 - CRIMINAL BACKGROUND CHECKS

Current through 2024-29, July 17, 2024
A.
Criminal
				background checks.
1. A TNA, prior to
				hiring, employing, or placing an individual in Maine who will work in direct
				contact with a consumer or who has direct access to a consumer's property,
				personally identifiable information, financial information or resources, shall
				obtain a comprehensive background check in accordance with 22 MRS Ch. 1691,
				Maine Background Check Act.
2. The
				comprehensive background check must be completed through the Maine Background
				Check Center (MBCC.)
3. The TNA
				must pay for the criminal background check required by this section.
4. The TNA must retain the report from the
				MBCC indicating the employee's eligibility for hire and make this report
				available to the health care facility or setting upon request.
5. A report from the MBCC indicating that a
				certified nursing assistant (CNA) is eligible for hire satisfies the
				requirement that the TNA verify that a CNA is listed on the Maine Registry of
				Certified Nursing Assistants and Direct Care Workers established under 22 MRS
				§ 1812-G with no annotations to prohibit the hiring of that individual, in
				accordance with 22 MRS §2131 (1-A).
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 111 - TEMPORARY NURSE AGENCY LICENSING RULE › Section 144-111-7 - ENFORCEMENT

Current through 2024-29, July 17, 2024
A.
Compliance.
1. The Department will issue a statement of
				deficiencies (SOD) for any violation of this rule. This SOD will be issued, via
				email, to the email address on file with the Department.
2. A TNA must submit and the Department must
				receive an acceptable Plan of Correction (POC) within ten business days of
				receipt of a SOD.
3. An acceptable
				POC must contain the following elements for each and every specific deficiency:
a. How the TNA will address any processes and
				systems issues that led to the deficiency;
b. The procedure for implementing the POC and
				the date of implementation;
c. The
				monitoring procedure to ensure that the POC is effective and the specific
				deficiency cited remains corrected and in compliance with this rule, including
				the timeframe and processes for monitoring to ensure continued compliance after
				the date of completion; and
d. The
				title of the person responsible for implementing the acceptable POC.
e. A POC may not contain any patient's or
				client's name or protected health information.
f. Failure to correct any deficiency(ies), or
				to file an acceptable timely POC, may lead to further action by the
				Department.
4. The
				Department will review the submitted POC and determine if the plan is
				acceptable or not and will notify the TNA in writing if the POC is acceptable
				or not.
a. If the POC is not acceptable, the
				Department will request a revised POC.
b. Failure to submit an acceptable POC may
				result in revocation or suspension of a registration.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 112 - REGULATIONS FOR THE LICENSING OF HOSPITALS › Section 144-112-1 - DEFINITIONS

Current through 2024-29, July 17, 2024
As used in this rule, unless the context indicates otherwise,
				  the following terms have the following meanings:
1.1
Applicant.
An applicant is
				any person, firm, partnership, association, corporation, or other entity
				requesting a license pursuant to these rules.
1.2
CMS. "
CMS" means the United
				States Department of Health and Human Services Centers for Medicare and
				Medicaid Services.
1.3
Critical Access Hospital.
"Critical Access Hospital", as established
				pursuant to
				 22 M.R.S.A.
				§7932(10), means a
				rural hospital which provides not more than 25 beds for acute hospital-level
				inpatient care. A swing-bed facility may have up to 25 inpatient beds that can
				be used interchangeably for acute or skilled nursing care. In addition to the
				25-bed limit for acute inpatient care, a Critical Access Hospital may have
				distinct parts with 10 or fewer psychiatric inpatient beds, or 10 or fewer
				inpatient rehabilitation beds, or both. In order to be a Critical Access
				Hospital, inpatient care may not exceed on an annual average basis, 96 hours
				per patient.
1.4
Department.
Unless otherwise indicated, the "Department" means the Maine Department
				of Health and Human Services.
1.5
General Hospital.
"General Hospital" means an acute health care
				facility with permanent inpatient beds planned, organized, operated, and
				maintained to offer for a continuing period of time, facilities and services
				for the diagnosis and treatment of illness, injury, and deformity; with a
				governing board, and an organized medical staff, offering continuous
				twenty-four hour professional nursing care; with a plan to provide, emergency
				treatment twenty-four hours a day. Any institution not meeting this definition
				of a general hospital is a specialty hospital. General hospitals do not include
				federal or state government controlled institutions, community health centers,
				independent outpatient diagnostic or treatment centers, doctors' offices,
				college infirmaries or industrial dispensaries. General hospitals include the
				provision of, either directly or indirectly, the following services or
				organizational units:
1.5.1 Governing
				Board
1.5.2
				Administration
1.5.3 Medical
				Staff
1.5.4 Nursing
				Services
1.5.5 Emergency
				Services
1.5.6 Food and Dietetic
				Services
1.5.7 Medical
				Records
1.5.8 Imaging
				Services
1.5.9 Pathology or
				Laboratory Services, and
1.5.10
				Pharmacy Services.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 112 - REGULATIONS FOR THE LICENSING OF HOSPITALS › Section 144-112-3 - STANDARDS

Current through 2024-29, July 17, 2024
3.1
Federal standards and
				certification requirements.
All applicants and licensees must comply
				with the federal standards and certification requirements for hospitals,
				adopted by the United States Department of Health and Human Services Centers
				for Medicare and Medicaid Services (CMS) as set forth in
				42 C.F.R. §
										482.1 through §
									482.104
				and§
									485.601
				through§
									485.647,
				revised as of October 1, 2007, which is incorporated herein by reference.
3.1.1 Copies of the federal standards and
				certification requirements can be found at
				42 C.F.R. §
											482.1 through §
										482.104
				and§
										485.601
				through§
										485.647,
				revised as of October 1, 2007, or may be obtained from the Maine Department of
				Health and Human Services, Division of Licensing and Regulatory Services, 11
				State House Station, Augusta, Maine 04333, orthe Maine Office of the Secretary
				of State, 101 State House Station, Augusta, Maine 04333.
3.1.2 A violation of any of the federal
				standards and certification requirements constitutes a violation of the state
				of Maine Rules for the Licensing of Hospitals, 10-144 C.M.R. Ch. 112.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 112 - REGULATIONS FOR THE LICENSING OF HOSPITALS › Section 144-112-4 - COMPLAINT INVESTIGATION AND INCIDENT REPORTS

Current through 2024-29, July 17, 2024
4.1
Complainant resolution.
Complainants shall be encouraged to resolve complaints directly with the
				hospital before initiating a department complaint investigation.
4.1.1
Consumer education.
Each
				hospital must publish a toll-free telephone number for complainants to contact
				the hospital. Each hospital must educate the public about hospital complaint
				resolution procedures. At a minimum, each hospital must post information in a
				public part of the hospital explaining the complaint resolution procedures and
				listing the toll-free complaint telephone number.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 113 - Regulations Governing the Licensing and Functioning of Assisted Housing Programs (includes Assisted Living Programs, Residential Care Facilities, and Private Non-Medical Institutions) (formerly 10-149 Ch. 113) › Assisted Living Programs › Section 144-113-1 - Purpose

Current through 2024-29, July 17, 2024
These rules establish minimum standards for the licensing
					 of assisted living programs. Assisted living services is the provision by an
					 assisted living program, either directly by the provider or indirectly through
					 contracts with persons, entities or agencies, assistance with activities of
					 daily living and instrumental activities of daily living, personal supervision,
					 protection from environmental hazards, meals, diet care, care management and
					 diversional or motivational activities. Assisted living programs must be
					 consumer oriented and meet professional standards of quality.
Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 113 - Regulations Governing the Licensing and Functioning of Assisted Housing Programs (includes Assisted Living Programs, Residential Care Facilities, and Private Non-Medical Institutions) (formerly 10-149 Ch. 113) › Assisted Living Programs › Section 144-113-3 - Licensing

Current through 2024-29, July 17, 2024
3.1
Responsibility for
				  compliance
. The applicant/licensee shall comply with these
				  regulations.
3.2
Unlicensed
				  assisted living program
. No person, firm, partnership, association,
				  corporation or other entity shall manage or operate an assisted living program
				  without a license.
3.3
Person license issued to
. The license is only valid for the named
				  licensee(s).
3.4
Application
				  and licensure
.
3.4.1
Application required
. The applicant is required to submit a written
				  application for a license on a form approved by the department. A license must
				  be issued prior to the commencement of operation, or the applicant may be
				  subject to sanctions. Incomplete applications, on which no action has been
				  taken by the applicant after sixty (60) calendar days, shall be void.
3.4.2 A non-refundable licensing fee of $200
				  shall be submitted with the application for each assisted living program. The
				  check shall be made payable to the Treasurer, State of Maine.
3.4.3 Annually thereafter a licensee fee of
				  $200 is required.
3.4.4
Admission and scope of services policy
. Assisted Living Programs are
				  required to provide the department with a written admission policy at the time
				  of application for a license. The policy shall describe who may be admitted and
				  scope of services provided, including scope of Nursing Services, consistent
				  with applicable state and federal law.
3.4.5
Additional licensing
				  requirements
. Prior to the issuance of a license and prior to
				  re-licensure, the assisted living program shall:
3.4.5.1 Be certified to be in compliance with
				  the National Fire Protection Association (NFPA) Life Safety Code. Assisted
				  living programs must be inspected using the section of the Life Safety Code
				  that applies to new apartment buildings and must be protected throughout by a
				  supervised, automatic sprinkler system approved by the Commissioner of Public
				  Safety.
3.4.5.2 Comply with all
				  applicable laws and regulations promulgated there under, relating to fire
				  safety, plumbing, water supply, sewage disposal and maintenance of sanitary
				  conditions (Class I, II, III).
3.4.5.3 Comply with all other applicable laws
				  and regulations pertaining to licensing.