Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 193 - OFFICE OF ADULT MENTAL HEALTH › Chapter 6A - MENTAL HEALTH LICENSING REGULATIONS › Subchapter - PNMI

Current through 2024-29, July 17, 2024
SUMMARY:
These regulations describe the
				  licensing standards for Private Non-Medical Institutions (PNMIs) which can be
				  either providers of community supports (CS) or residential services (RS). These
				  PNMIs are separately licensed for purposes of identifying them as providers who
				  bill MaineCare under Section
				  97 for private non-medical institution
				  services and are required to meet special requirements. These regulations
				  become effective retroactive to July 1, 2004.
GENERAL PROVISIONS: PRIVATE NON-MEDICAL
				  INSTITUTIONS
A Private Non-Medical Institution (PNMI) licensed under this
				  chapter is a MaineCare provider that is required to meet special requirements
				  to provide either Community Supports (CS) or Residential Services (RS). In
				  addition to surveying for compliance with the core standards, except as noted
				  below, an agency providing PNMI services will also be surveyed according to the
				  services they provide. In this way, an agency is given a tailored survey that
				  reviews the full scope of their services.
PNMI services may include supported housing, residential
				  programs, or intensive in-home supports. These services may be provided at an
				  individual or scattered sites. For purposes of this subchapter, a PNMI means a
				  person licensed by the Department of Health and Human Services to provide PNMI
				  services to four or more MaineCare and other residents in single or multiple
				  facilities under a written agreement with the State of Maine. A PNMI shall not
				  be a health insurance organization, hospital, nursing home or community health
				  care center.
PNMI services may also include community residences for
				  persons with mental illness for the integrated treatment of persons with dual
				  disorders, which provide mental health and substance abuse treatment services
				  to individuals with coexisting disorders of mental illness and substance abuse.
				  These residences shall be licensed as provided herein and must also be
				  receiving funds from the Department of Health and Human Services for the
				  treatment of persons with dual disorders. For PNMI services provided in
				  scattered site apartments or in a client's own home, a provider shall not be
				  required to comply with GOV.11, HS.4, HS.5, PHY.2 or PHY.3, insofar as those
				  standards would affect the apartment or home.
All PNMIs licensed under this subchapter shall provide the
				  Department with evidence of compliance with PNMI tax reporting requirements.
				  The provider must have a provider agreement on file with the Department of
				  Health and Human Services, Bureau of Medical Services.
Providers must also contract with the Department of Health
				  and Human Services and satisfactorily meet all contract and provider agreement
				  provisions.
A PNMI provider is permitted under the rules to provide
				  certain types of services using appropriately qualified staff. Direct services
				  include, but are not limited to, the following: physician services;
				  psychiatrist services; psychologist services; psychological examiner services;
				  social worker services; licensed clinical professional counselor services;
				  licensed professional counselor services; dentist services; registered nurse
				  services; licensed practical nurse services; psychiatric nurse services; speech
				  pathologist services; licensed alcohol and drug counselor services;
				  occupational therapy services; other qualified mental health staff services;
				  other qualified medical and remedial staff services; other qualified alcohol
				  and drug treatment staff services; personal care services; interpreter
				  services; nurse practitioner services, physician assistant services; clinical
				  consultant services; physical therapy services.
The above services must be provided by the following licensed
				  or registered professional staff members: dentists, licensed alcohol and drug
				  counselors, licensed clinical professional counselors, licensed professional
				  counselors, nurse practitioners, occupational therapists, physicians, physician
				  assistants, licensed practical nurses, psychiatrists, psychiatric nurses,
				  psychologists, psychological examiners, registered nurses, social workers, or
				  speech language pathologists. All providers must hold appropriate licensure in
				  the State or Province in which services are provided and must practice within
				  the scope of these licensing guidelines. Clinical consultant services must be
				  provided by licensed or certified professionals within all State and Federal
				  regulations specific to the services provided.
Other staff may be considered qualified for purposes of this
				  rule if they meet the following requirements:
1. they have the education, training or
				experience that qualifies them to perform certain specified mental health
				functions;
2. they receive
				certification from the Department of Health and Human Services, or its
				designee, that they are qualified to perform such functions and such
				verification is recorded in writing and kept in the files or the Department or
				its designee; and
3. they perform
				such functions under the supervision of a licensed, certified or registered
				health professional with the supervisory relationship have been described to
				and approved by the Department in accordance with its licensing and
				certification rules.
Personal care service staff may be considered qualified for
				  purposes of this rule if they perform personal care services and have met
				  minimum training requirements set by the Department for the provision of
				  personal care services in community residences for people with mental
				  illness.
It is the responsibility of the PNMI provider to coordinate
				  PNMI services with "in-home" and other services to address the full range of
				  the client's needs. The PNMI provider shall not arrange for others to provide
				  services which duplicate PNMI services included in the facility's PNMI rate. In
				  order to avoid duplication of services, staff providing case management
				  services as part of PNMI treatment shall coordinate their services with case
				  managers providing services outside the residential setting.
A PNMI is subject to the surveillance and utilization review
				  provisions set out in the MaineCare Benefits Manual, Chapter I. Any required
				  time studies shall be done in accordance with the MaineCare Benefits Manual,
				  10-144 C.M.R. Ch. 101, and shall be documented in the facility.
SPECIFIC PROVISIONS: Private Non-Medical
				  Institutions-Community Supports (PNMI-CS)
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 waiting 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.