Current through 2024-52, December 25, 2024
107.07-01
Licensing, Certification, and Accreditation
A. All PRTFs must maintain current CMS
certification and state licensure as administered by the Department of Health
and Human Services.
B. All PRTFs
must maintain current accreditation by one of the following entities:
1. The Joint Commission on Accreditation of
Healthcare Organizations, or
2. The
Commission on Accreditation of Rehabilitation Facilities, or
3. The Council on
Accreditation
C. All
accreditation reports, with findings & remediation, must be submitted to
the Maine Center for Disease Control and Prevention (CDC).
107.07-02
Enrollment
A. All PRTFs must maintain enrollment with
MaineCare according to the terms of Chapter I Section 1 of the MaineCare
Benefits Manual.
B. All PRTFs, upon
enrollment with MaineCare, must attest, in writing, that the facility is in
compliance with CMS's standards governing the use of restraint and seclusion.
This attestation must be signed by the facility medical
director.
107.07-03
Qualified Providers
PRTF Programs must have appropriately credentialed staff,
as described in the roles below, to satisfy the minimum staffing requirement
for covered services described in Appendix D. Roles and qualified providers are
described as follows:
A. Medical
Director - is responsible for overall program implementation, individualized
treatment planning, interventions, and key decision-making regarding an
individual's treatment. The medical director must be licensed to practice in
the State of Maine and be held by at least one of the following:
1. Board-eligible or board-certified
psychiatrist, or
2. Licensed
Psychologist AND a physician licensed to practice medicine or osteopathy
practicing as co-directors to fulfill the above medical director
duties.
B. Administrator-
is responsible for business oriented decisions regarding the PRTF. The Program
Administrator must be at least 21 years of age, have a Bachelor's Degree from
an accredited school and two years of experience in the management and
supervision of personnel and children's care facilities, or comparable training
or experience. Duties include, but are not limited to: oversight of day-to-day
operations, scheduling, ensuring staff training, and maintaining the physical
plant.
C. Clinical Coordinator - is
responsible for the oversight of the implementation of a member's clinical
interventions. The Clinical Coordinator will provide supervision, training, and
clinical support staff clinician(s). Additionally, the Clinical Coordinator
must serve on the member's team to develop the ITP and must facilitate the
member's discharge and transition to aid in ensuring a successful transition
from the PRTF. A clinical coordinator must be held by one of the following:
1. A LCSW with at least two years of
experience in the diagnosis and treatment of children with serious behavioral
health conditions (experience may include experience gained while obtaining
clinical licensure status as an LMSW-CC), or
2. A Licensed Psychologist by the State of
Maine.
D. Staff Clinician
- is responsible for the implementation of the clinical services offered by the
PRTF. The clinical services include at minimum a mixture of individual, group,
and family therapy provided at the levels outlined in Section.
A Staff Clinician may be any of the following:
1. A fully Licensed Clinical Social Worker
(LCSW);
2. A fully Licensed
Clinical Professional Counselor (LCPC); or
3. A fully Licensed Marriage and Family
Therapist (LMFT).
E.
Nurse - is responsible for the support of the behavioral health, wellness, and
medical needs of a member receiving PRTF services. There must be a nurse
present in the PRTF 24 hours per day, 365 days per year. The Nurse must be
either:
1. A psychiatric mental health nurse
practitioner or
2. A registered
nurse with at least two years' experience in the treatment of children with
serious behavioral health conditions.
F. Nurse Support - is responsible for
supporting the Nurse in duties allowable by the scope of their licensure
including the administration of medications as well as assistance with personal
care activities. The Nurse Support must be either:
1. A Certified Nursing Assistant-Medication
Aide (C.N.A.-M) listed on the Maine C.N.A. Registry with no disqualifying
annotations and two years of experience as a C.N.A.-M. responsible for the
administration of medications as well as assistance with personal care
activities; or
2. A Licensed
Practical Nurse (LPN) with at least two years' experience in the treatment of
children with serious behavioral health conditions.
G. Direct Care Staff - is responsible for the
daily implementation of the direct program. Direct support staff must be
present 24 hours per day, 365 days per year. Direct care staff are critical
staff required to maintain structure and safety within the program, and to
implement a member's individualized programming. A Direct Care Staff must hold
current Behavioral Health Professional certification (BHPs) with at least two
years' experience working as a BHP with a related population.
107.07-04
Treatment Planning
Team
The Treatment Plan must be developed by an
interdisciplinary team within the PRTF. This team may also include any
Ancillary service providers as medically indicated.
The member must be involved in the planning process to
the greatest degree possible. The member's parent or guardian (when applicable)
must be involved in the planning process. The team, based on education and
experience (including competence in child psychiatry) must be capable
of:
A. Assessing the member's
immediate and long-term therapeutic needs, developmental priorities, and
personal strengths and liabilities;
B. Assessing the potential resources of the
member's family;
C. Setting
treatment objectives; and
D.
Prescribing therapeutic modalities to achieve the plan's objectives.
E. The team must include:
1. The Medical Director;
2. Clinical Coordinator; and
3. One of the following:
a. Registered Nurse with specialized training
or one year's experience in treating mentally ill individuals; OR
b. A psychologist who has a master's degree
in clinical psychology or who has been certified by the State or by the State
psychological association.
107.07-05
Supervision
Requirements
A. The facility must
assign a supervisor to each staff member based on the staff member's roles and
responsibilities.
1. BHPs must be supervised
by a Staff Clinician (LCSW, LCPC or LMFT) for the purposes of treatment plan
implementation.
2. RNs must be
supervised by a physician or nurse practitioner.
3. LPNs and CNA-Ms must be supervised by RNs
or nurse practitioners.
4. Staff
Clinicians will be supervised by the Clinical Coordinator.
5. The facility Administrator will provide
supervision regarding any administrative or operational issues.
B. Supervisors must meet with
assigned staff at least one hour per week, either individually or in a group
format. The supervisory sessions must be documented. At least one hour per
month must be individual supervision.
107.07-06
Required Disclosures and
Informed Consents
A. At the time of
admission, the facility must:
1. Inform the
incoming member and, in the case of a minor, the member's parents or legal
guardians, of the facility's policy regarding the use of restraint or seclusion
during an emergency safety situation that may occur while the member is in the
program;
2. Communicate its
restraint and seclusion policy in a language that the member and his or her
parents or legal guardians understand and when necessary, the facility must
provide interpreters or translators;
3. Obtain an acknowledgement, in writing,
from the member, or in the case of a minor, from the parent or legal guardian
that he or she (or they) have been informed of and have received the facility's
policy on the use of restraint or seclusion during an emergency safety
situation. Staff must file this acknowledgement in the member's
record;
4. Provide a copy of the
facility policy on the use of restraint or seclusion during an emergency
situation to the member and in the case of a minor, to the member's parents or
legal guardians; and
5. Provide
contact information, including the phone number and mailing address, for the
State Protection and Advocacy Organization.
6. Advise the member and the member's parent
or legal guardians (as applicable) in understandable terms of the member's
rights pursuant to the Rights of Recipients of Mental Health Services
Who are Children in Need of Treatment, 14-172 C.M.R. ch. 1, and
provide a copy of these rights to the member and the member's parents or legal
guardians (as applicable). For members 18 years of age and older or who are
emancipated minors, also advise the member and the member's legal guardian (as
applicable) in understandable terms of the member's rights pursuant to
the Rights of Recipients of Mental Health Services, 14-193
C.M.R. ch. 1, and provide a copy of these rights to the member and the member's
legal guardian (as applicable). The member's parent/guardian must sign
acknowledgement that the member's rights have been reviewed and the publication
has been received.
7.
Acquire informed consent for services from the member and his or her
parent/guardian, when applicable. Informed consent means sharing, in writing, a
description of the services being provided, service goals, service
expectations, disclosure of risks and benefits and the roles and the
responsibilities of the Provider and the family toward meeting service goals
and expectations. Proof of Informed Consent will be documented, and signed by
the Provider and the parent/guardian. Additional requirements are as follows:
a. The Provider shall document in the
member's plan the treatment or service delivery method or model for each
service provided to a client, indicating full disclosure to the child, youth,
parent and guardian of the risks and benefits of the method or model and
alternative methods or models.
b.
The Provider shall review with the member and his or her parent/guardian, when
applicable upon intake, its role and responsibility as a mandated reporter of
abuse and/or neglect pursuant to
22
M.R.S. §3477 and
22 M.R.S.
§4011-A and document this disclosure
within the client record.
c. The
Provider shall secure consent from the member and his or her parent/guardian,
when applicable, to use the disclosed methods of intervention to treat the
identified areas of need in the member's Individualized Treatment Plan. The
Provider shall document the consent within the member's service
record.
d. The Provider shall
consider available Evidence-Based Practices and consider using such practices
when clinically appropriate for the member's condition. Provider staff shall
understand and consider empirical evidence, clinical expertise, and the values
and preferences of families and youth in implementing treatments.
e. The Provider shall clearly document the
target symptoms of the treatment, how they will be measured and improvement
determined.
107.07-07
Provider Documentation
Requirements and Member Record
A.
Assessment and Evaluation
1. The Provider
shall conduct an initial assessment and evaluation in accordance with
§107.5-1.A within seventy-two (72) hours of admission, with a full
comprehensive assessment and evaluation completed within fourteen (14) days of
admission to the facility.
2. The
assessment and evaluation must consist of direct and indirect encounters.
Direct encounter shall include a psychological assessment and medical
evaluation (to include medication review) directly with the member. Indirect
encounters consist of record review and may include conversations with the
member's parent/guardian (as applicable), teachers, other professionals
involved, and natural supports (as applicable). Direct and indirect encounters
must inform the medical, psychological, social, behavioral and developmental
aspects of the member's situation, and reflects the need for inpatient
psychiatric care. Assessment and evaluation will be conducted to the extent
necessary to determine the member's current disposition and treatment
recommendations.
3. Documents
submitted to the PRTF by the CCON team in accordance with 107.04-02.B may be
used to satisfy parts of the documentation requirements for the initial and/or
full comprehensive assessment.
4.
The assessment must contain documentation of the member's current status, the
reason for referral to the service, history, strengths and needs in the
following domains: personal, family, social, emotional, psychiatric,
psychological, medical, drug and alcohol (including screening for co-occurring
services), legal, permanency/housing, financial, vocational, educational,
leisure/recreation, transition needs (when applicable), potential need for
crisis intervention, physical/sexual and emotional abuse (including trauma
history). The assessment must review cultural needs including issues of
literacy and English and language barriers, and the need for interpretation and
other needed services. The assessment should also take into consideration the
member's expressed desires.
5. The
assessment shall contain documentation of developmental history, sources of
support that may assist the member to sustain treatment outcomes including
natural and community resources and state and federal entitlement programs. The
assessment shall address physical and environmental barriers to treatment and
current medications. Domains addressed must be clinically pertinent to the
service being provided.
6. For a
member with substance abuse, the documentation must also contain age of onset
of alcohol and drug use, duration, patterns and consequences of use, family
usage, types and response to previous treatment.
7. The provider will review the member's CANS
assessment as a part of the full comprehensive assessment and will review the
CANS ongoing in coordination with the member's treatment plan intervals
described below in 107.07-07.B.2.
8. The assessment must be summarized to
include a clinical formulation that summarizes the strengths and needs of the
member and family (when applicable) that informs treatment, service intensity,
and recommendations for service. The formulation will include intended
intervention modalities. The assessment must include a diagnosis using the most
recent version of the Diagnostic and Statistical Manual of Mental
Health Disorders (DSM) or the Diagnostic Classification of Mental
Health and Development Disorders of Infancy and Early Childhood (DC 0-5), as
appropriate. The assessment must be signed, credentialed and dated by the
appropriate personnel conducting the assessment.
B. Treatment Plan
1. All members must have an active Treatment
Plan, which must:
a. Be developed and
implemented in a timely manner; an initial treatment plan must be developed and
implemented within 72 hours of admission while a more comprehensive treatment
plan must be developed and implemented within 14 days of admission.
b. Be developed by the Treatment Planning
Team as described in Section 107.07-04 of this policy;
c. Be developed based on the Assessment
completed in accordance with Section 107.07-07.A;
d. Reflect the needs and strengths identified
in the member's CANS assessment;
e.
Be designed to achieve the member's discharge from inpatient status at the
earliest possible time;
f. Describe
the functional level of the member;
g. Prescribe an integrated program of
therapies, activities, and experiences designed to meet the member's treatment
objectives, and include any orders for:
i.
Medications; and
ii. Treatments and
Therapy; and
iii. Social services;
and
iv. Special procedures
recommended for the health and safety of the member.
h. Include plans for continuing care,
including review and modification of the Treatment Plan;
i. Include clear short and long-term goals
and treatment objectives that are specific, measurable and are time limited to
include target dates, and include the frequency, intensity, and duration of
each described intervention;
j.
Describe the rationale for utilizing the prescribed treatment and
services;
k. Specify treatment and
service responsibility, including both staff and member responsibilities in
meeting the member's treatment objectives;
l. Be developed in consultation with the
member, the member's parents or legal guardians (where appropriate), or others
who will be caring for the member following discharge from the PRTF, including
but not limited to family, school officials, and community service providers;
and
m. Include a list of needs
identified in the assessment process that are not addressed in the Treatment
Plan and an explanation of why the identified needs are not
addressed;
n. Include a discharge
plan which must:
i. Identify individualized
discharge criteria that are related to the goals and objectives described in
the Treatment Plan;
ii. Identify
the individuals responsible for implementing the plan, including staff who can
assist the member in making referrals for other resources;
iii. Identify natural and other supports
necessary for the member and family to maintain the safety and well-being of
the member, and to sustain progress made during the course of treatment;
iv. Be reviewed by the treatment
planning team every review meeting and no less than every thirty (30) days;
v. Identify any service
recommendations and reasons for recommending that service;
vi. Address behavior planning, including
interventions and resources necessary to carry out the plan without supports;
and
vii. Contain a list of
resources tailored to the member's individualized needs and situation necessary
for parents, guardians, and natural supports to increase the likelihood of a
successful and sustainable discharge.
2. The Treatment Plan must:
a. Be entered in the member's medical record
upon initial completion and upon any alteration;
b. Consider any additional assessments in the
development of the Treatment Plan;
c. Be reviewed every 30 days, or sooner as
clinically indicated by the treatment planning team to:
i. Determine that services being provided are
required on an inpatient basis and
ii. Recommend changes in the plan as
indicated by the member's overall adjustment as an inpatient;
d. Document plan approval as shown
by the signature of the member (when applicable), parent/guardian (when
applicable), any staff with credential(s) involved in creating the treatment
plan, and the medical director with credential(s). All signatures will be dated
at the time of signature. In extenuating circumstances, verbal approval by the
parent/guardian may be obtained in lieu of signature which must be documented
in the member record with the staff member who received the approval (and
signature/date), and the reason why signature could not be obtained;
e. Be provided to the member and the member's
parent/guardian (if applicable) within five (5) working days from the date of
final plan approval.
C. Results of any assessments conducted must
be included in the member record.
D. Progress Notes:
1. Providers must maintain written progress
notes for each service discipline provided by the PRTF, in chronological order.
There must be one milieu note per shift and all medication/therapy services (as
defined under covered services Section 107.05-01.D) must be documented
individually. 2. All entries in the progress note must include the service
provided, the provider's signature and credentials, the date on which the
service was provided, the duration of the service, and the progress the member
is making toward attaining the goals or outcomes identified in the Treatment
Plan.
107.07-08
Additional Treatment Standards
In addition to the requirements detailed above, providers
must follow all the Treatment Standards described below:
A. Family Centered Practice
1. The treatment shall be tailored to return
the member to a family when possible and to a community. The Provider shall
include and support family members as extensively as possible from the
beginning of the admissions process through discharge, transition and
aftercare. Families shall be full partners in all aspects of the member's
treatment, barring any limitations on participation. The focus of treatment
shall be on helping families acquire the skills necessary to solve problems,
meet needs, and attain desired goals. Individualized Family Therapy goals shall
be included in the Treatment Plan.
2. It is the responsibility of the PRTF
Provider to work with the member and his or her family to continually pursue
effective levels of engagement with families, which include extended family
members and natural/informal supports.
3. Planning with families shall make every
effort to mobilize both informal and formal resources in support of
families.Informal/natural supports include identification of the member and
family's personal resources including their specific skills, capacities or
attributes. The PRTF staff shall work as a part of the team in exploring these
resources for families.
4. The
Treatment Planning Team shall address family readiness and the specific
supports needed to ensure placement stability and success.
5. The PRTF Provider will have a
family-centered policy including the following components, and will maintain
records documenting training of all staff in the policy. The family-centered
policy shall:
a. Ensure family involvement in
all aspects of the program (medical appointments, school communication, daily
living, daily programming, etc.);
b. Illustrate family's right to visitation
and treatment participation in the PRTF setting;
c. Expectations of family treatment &
daily living participation; and
d.
Define exceptions when limits are placed on family participation, including but
not limited to protect the member's welfare, as a result of a protection from
abuse or other court order, or a member age 18 years and older or an
emancipated minor who does not consent to family
participation.
6. The
PRTF Provider will provide parent with supports and treatment interventions
including psycho-educational, preventive, and supportive services as indicated
by assessments. The focus will be on enhancing the parents' coping mechanisms
and providing them with the tools to move towards self-sufficiency through
involvement in normal parenting activities and participating in positive
behavioral supports and management techniques. The program will actively engage
parental involvement and provide ongoing opportunities for parent to engage
within the daily life activities of the member in the PRTF setting. Sibling
involvement in treatment, visitation, and shared activities should be a part of
the family treatment.
7.
Documentation of parental presence and participation in treatment and typical
daily parenting activities, as well as sibling involvement shall be maintained
in the member's record. It is the responsibility of the PRTF Provider to
document its attempts and strategies for family engagement and to overcome
barriers to family participation in treatment.
B. Behavioral Support and Management
Standards
The PRTF shall practice positive behavior support
strategies. Interventions are designed to modify member behavior should be
individualized, respectful, developmentally appropriate, related to the issue
at hand, flexibly applied, and designed to help the child master age and
developmentally appropriate skills.
1.
All individualized positive behavior support plans shall be based on a
Functional Behavioral Assessment (FBA) by a qualified clinician or Board
Certified Behavioral Analyst, with specific training in FBAs.
2. All individual positive behavioral support
plans shall be monitored, reviewed, and adjusted on an ongoing basis based on
the member's behavior and response to treatment. Review shall not be limited
solely to the required 30-day Treatment Plan review.
a. Each behavioral plan shall include
strategies that encourage the use of adaptive and pro-social behaviors with the
goal of preventing aggressive behavior and de-escalating behavior before it
becomes necessary to use more restrictive measures. The member's trauma history
shall be considered in determining the most effective means to de-escalate
behavior.
3. Behavioral
interventions shall not be used as punishment, a form of discipline, or for the
convenience of staff.
4. All staff
will be trained in appropriate de-escalation techniques. Staff shall be
provided ongoing trainings and supervision around their use to ensure fidelity
to the model chosen by the provider.
C. Any use of outside resources to intervene
with psychiatric or behavioral occurrences must be reviewed and approved by the
Medical Director prior to the intervention. The approval, including rationale,
must be documented in the member record. This includes, but is not limited to
referring a member to psychiatric hospitalization and requesting police
intervention.
107.07-09
Education, Training Requirements and Background Checks
A. Required Background checks:
The following is required for all staff working in a
PRTF;
1. Background checks must be
completed in accordance with the facility's licensing requirement 10-144 C.M.R
Ch. 36;
2. Additionally, all
background checks must be performed at hire and every two years, at minimum,
thereafter;
3. Any potentially
adverse findings must be vetted by the provider and documented in the staff's
personnel record.
B. The
facility must require staff to have initial and ongoing training, education and
demonstrated knowledge of:
1. Techniques to
identify staff and member behaviors, events, and environmental factors that may
trigger emergency safety situations;
2. The use of non-physical intervention
skills, such as de-escalation, mediation conflict resolution, active listening,
and verbal and observational methods, to prevent emergency safety situations;
and
3. The safe use of restraint
and the safe use of seclusion, including the ability to recognize and respond
to signs of physical distress in members who are restrained or in
seclusion.
C.
Certification in the use of cardiopulmonary resuscitation (CPR), including
periodic recertification, is required. Certification and staff competency in
the use of CPR must be reviewed on an annual basis.
D. First aid certification is required.
Certification must be reviewed on an annual basis.
E. Staff trainings must be provided by
individuals who are qualified by education, training and experience to provide
such training.
F. Staff training
must include training exercises in which staff members successfully
demonstrate, in practice, the techniques they have learned for managing
emergency safety situations.
G.
Staff must be trained and demonstrate competency before participating in an
emergency safety intervention.
H.
Staff must demonstrate their competencies and proficiencies in the skills
described in subsection (B) above every six months.
I. The facility must document in the staff
personnel records that the training and demonstration of competency were
successfully completed. Documentation must include the date training was
completed and the name of persons certifying the completion of
training.
J. All training programs
and materials used by the facility must be available for review by CMS, the
Office of MaineCare Services, Maine CDC, and the Office for Child and Family
Services.
107.07-10
Reporting of Serious Occurrences
A. PRTFs must report each Serious Occurrence
to:
1. The Office of MaineCare Services;
2. The Office of Child and Family
Services (OCFS);
3. Maine CDC;
and
4. The Department's State
Protection and Advocacy Agency.
B. Reports must be made by the close of
business the next business day following a Serious Occurrence.
C. The report must include the name of the
member involved in the serious occurrence, a description of the occurrence, and
the name, street address, and telephone number of the facility.
D. If the member involved is a minor, the
facility must notify the member's parents or legal guardians as soon as
possible, and in no case no later than 24 hours after a Serious Occurrence.
E. Staff must document in the
member's record that the serious occurrence was reported to the agencies as
required in this provision, including the name of the person to whom the
incident was reported.
F. A copy of
the report must be maintained in the member's record, as well as in the
incident and accident report logs maintained by the facility.
G. In the event of a member death, the
following additional reporting and documentation must be made:
1. Facilities must report the death of any
member to the Centers for Medicare and Medicaid Services (CMS) regional office
no later than close of business the next business day after the member's death;
and
2. Staff must document in the
member's record that the death was reported to the CMS regional
office.
H. In certain
circumstances, additional reports must be made to Child Protective services for
youth under 18 years old per
22 M.R.S.
§4011-A, or Adult Protective Services
for individuals 18 years and older per
22
M.R.S. §3477.