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-31 - Federally Qualified Health Center Services › Subsection 144-101-II-31.06 - POLICIES AND PROCEDURES

Current through 2024-29, July 17, 2024
31.06-1
Professional and Other Qualified Staff
In order for a Federally Qualified Health Center to
						receive reimbursement, its professional staff must be conditionally,
						temporarily or fully licensed, in the statewhere services are provided, as
						documented by written evidence from the appropriate governing body, including:
						physicians, podiatrists, physician assistants, advanced practice registered
						nurses, clinical psychologists, clinical social workers, clinical professional
						counselors, registered nurses, licensed practical nurses, respiratory
						therapists, dentists, independent practice dental hygienists (effective October
						1, 2013, subject to approval by CMS), and dental hygienists. Other qualified
						staff include: dental externs (added effective July 1, 2013) and dental
						residents (added effective July 1, 2013) as defined in the
MaineCare
						Benefits Manual
, Chapter II - Section 25: Dental Services, who must
						have a current permit from the Maine Board of Dental Examiners. MaineCare will
						also reimburse for advanced practice or registered nurses who hold a current,
						unencumbered compact license from another compact state that they claim as
						their legal residence. Qualifications of any other staff must be provided and
						billed in accordance with all other applicable sections of the
MaineCare Benefits Manual
.
31.06-2
Supervision by a Physician or
					 Other Licensed Practitioner
Medical services rendered under this policy must be
						provided under the supervision of a physician, or other suitably licensed
						practitioner, to the extent required by applicable statelaws or regulations.
						Clinical psychologists, LCSWs, LCPCs, dentists, and other non-medical staff are
						not subject to the supervision of the physician.
Physician supervision must be performed in accordance
						with the Maine Board of Licensure in Medicine or the Maine Board of Licensure
						in Osteopathy requirements. Dental services rendered under this policy must be
						performed in accordance with the Maine Board of Dental Examiners
						requirements.
31.06-3
Member Records
There shall be a specific record for each member, which
						shall include, but not necessarily be limited to:
A. the member's name, address and birth
					 date;
B. the member's social and
					 medical history, as appropriate;
C.
					 a description of the findings from the physical examination;
D. long- and short-range goals, as
					 appropriate, except for clinical psychologist, licensed clinical social worker
					 and licensed clinical professional counselor services, where a mental health
					 treatment plan containing long- and short-term goals and signed by both the
					 provider and the member, must be developed by the third session, and updated
					 with signatures at least quarterly thereafter;
E. a description of any tests ordered and
					 performed and their results;
F. a
					 description of treatment or follow-up care and dates scheduled for
					 revisits;
G. any medications and/or
					 supplies dispensed or prescribed;
H. any recommendations for and referral to
					 other sources of care;
I. the dates
					 on which all services were provided; and
J. written progress notes, which shall
					 identify the services provided and progress toward achievement of
					 goals.
K. for members with a
					 history of chronic mental illness, who receive ongoing outpatient therapy by
					 LCSWs, LCPCs, psychologists or advanced practice psychiatric nurses, or who
					 receive medication management from advanced practice psychiatric nurses, the
					 following additional record-keeping requirements apply:
1.
Initial Assessment/Clinical
					 Evaluation
. An initial assessment, which must include a direct encounter
					 with the member, and his/her family if appropriate, shall be performed and
					 included in the member's FQHC record. The assessment must include the member's
					 medical and social history and must include the member's diagnosis and the
					 professional who made the diagnosis and that person's credentials.
2.
Individual Treatment/Service
					 Plan
. An individual treatment/service plan must be developed by the
					 third mental health visit. This individual treatment/service plan shall be in
					 writing and shall identify mental health treatment needs, and shall delineate
					 all specific services to be provided, the frequency and duration of each
					 service, the mental health personnel who will provide the service, and the
					 goals and/or expected outcomes of each service. Treatment plans must be
					 reviewed and approved by a psychiatrist, physician, psychologist, or licensed
					 clinical social worker, licensed clinical professional counselor or advanced
					 psychiatric and mental health nurse, or a registered nurse certified in the
					 specialized field of mental health within thirty (30) days of entry of the
					 member into mental health treatment.
3. Written treatment or progress notes shall
					 be maintained in chronological order, and shall be made for each mental health
					 visit. These notes shall identify who provided the service, the provider's
					 credentials, on what date the service was provided, its duration, and the
					 progress the member is making toward attaining the goals or outcomes identified
					 in the treatment plan.
4. The
					 clinical record shall also specifically include written information or reports
					 on all medication reviews, medical consultations, psychometric testing, and
					 collateral contacts made on behalf of the member (name, relationship to member,
					 etc.).
5. In cases where FQHC
					 mental health services are needed in excess of two hours per week to prevent
					 hospitalization, documentation must be included in the file and signed by a
					 psychiatrist, physician, psychologist, licensed clinical social worker,
					 licensed clinical professional counselor or psychiatric nurse.
6.
Discharge/Closing Summary
. A
					 closing summary shall be signed and dated and included in the clinical record
					 of discharge treatment and outcome in relation to the individual
					 treatment/service plan.
7. In the
					 event a member receives group services, there shall be no names of other group
					 participants in the member's record. Entries are required for each service
					 billed and must include the name, credentials, and signature of the service
					 provider. See Chapter I of the
MaineCare Benefits Manual
for
					 additional record keeping requirements.