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-18 - RULES GOVERNING IMPLEMENTATION OF THE TRADE ADJUSTMENT ASSISTANCE PROGRAM
Subsection 144-101-II-18.10 - PROVIDER QUALIFICATIONS AND REQUIREMENTS
Current through 2024-38, September 18, 2024
To provide services under this section a provider must be a qualified vendor as approved by DHHS and enrolled by the MaineCare program. Once a provider has been authorized to provide services, the provider cannot terminate the member's services without written authorization from DHHS. Written documentation of all certifications, and licensure requirements and date of hire must be contained in a personnel file.
In order for services to be reimbursable, a Provider must meet the following standards:
18.10-1 Assistive Technology Services-In order to provide Assistive Technology Services, a provider must be an OADS-approved agency and the individual providing the services must meet one of the following training requirements:
18.10-2 Care Coordination Services- In order to provide Care Coordination Services, a provider must be an OADS-approved, CARF-accredited agency consistent with the requirements of Section 18. 10-13 and employ staff who are Certified Brain Injury Specialist (CBIS) certified consistent with the requirements of Section 18. 10-14or other Department approved curriculum within the first 12 months of employment and be a:
18.10-3 Career Planning - In order to provide Career Planning Services, a provider must be an OADS-approved Provider Agency and the individual providing the service must meet one of the following training requirements and must have completed an additional 6 hours of Career Planning and Discovery training provided through Maine's Workforce Development System:
18.10-4 Employment Specialist Services - In order to provide Employment Specialist Services, a provider must be an OADS-approved Provider Agency and the individual providing the services must be nationally certified by the Association of Community Rehabilitation Educators (ACRE) and maintain that certification through meeting ongoing continuing education requirements.
18.10-5 Home Support Level I, Level II, and Level III and Remote Support- In order to provide Home Support Services, a provider must be an OADS-approved Provider Agency and must have Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation (or provisional certification), consistent with the requirements of Section 18. 10-13, in the Home and Community Services, Residential Services and Brain Injury Modules. All staff providing Home Support Services must:
To qualify as a Direct Support Professional, an individual must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or demonstrated proficiency through DHHS's approved Assessment of Prior Learning, or successfully complete the curriculum from the Maine College of Direct Support (CDS) within six (6) months of date of hire. The Maine College of Direct Support is accessed on the internet at: http://www. maine. gov/dhhs/oads/disability/ds/cds/index. shtml;
Or
To qualify as a Personal Support Specialist an individual must meet one of the training and examination requirements below. An individual without the required training may be hired and reimbursed for delivering personal care services as long as the individual enrolls in a certified training program within sixty (60) days of hire and completes training and examination requirements within nine months of employment and meets all other requirements. If the individual fails to pass the examination within nine months, reimbursement for his or her services must stop until such time as the training and examination requirements are met. A PSS must hold a valid certificate of training as a personal support specialist/personal care assistant issued as a result of completing the Department-approved personal support specialist training curriculum and passing the competency-base examination of didactic and demonstrated skills. The training course must include at least 50 hours of formal classroom instruction, demonstration, return demonstration, and examination. Tasks covered under this Section must be covered in the training;
AND
Documentation of completion must be retained in the personnel record.
18.10-6 Self Care/Home Management Reintegration and Community/Work Reintegration- In order to provide Self Care/Home Management Reintegration or Community Work Reintegration Services, a provider must be an OADS-approved Agency and must have Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation (or provisional certification), consistent with the requirements of Section 18. 10-13, in the Outpatient Medical Rehabilitation, section 2-Medical Rehabilitation, Home and Community Based Services and Brain Injury modules. Allstaff providing Self Care / Home Management Reintegration or Community / Work Reintegration Services must:
18.10-7 Work Ordered Day Club House - In order to provide Work Ordered Day Club House Services, a provider must be an OADS-approved Provider Agency and must have Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation (or provisional certification), consistent with the requirements of Section 18. 10-13, in the Home and Community Services and Brain Injury Modules. All staff providing Work Ordered Day Club House Services must:
18.10-8 Work Support- In order to provide Work Support, a provider must be an OADS Approved Provider Agency and must have Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation (or provisional certification), consistent with the requirements of Section 18. 10-13, in the Outpatient Medical Rehabilitation, Section 2-Medical Rehabilitation, Home and Community Based Services and Brain Injury modules. All staff providing Work Support Services must:
A DSP who also provides Work Support must have completed the additional employment modules in the Maine College of Direct Support (CDS) in order to provide services.
Employment Specialist National (ACRE approved) Certification may be substituted for CDS and employment modules as it is a higher level of staff certification.
AND:
18.10-9 Background CheckCriteria- Providers must conduct criminal and child and adult protective services background checks on all prospective employees, persons contracted or hired, consultants, volunteers, students, and other persons who may provide services under this Section. Background checks on persons professionally licensed by the State of Maine must include a confirmation that the licensee is in good standing with the appropriate licensing board or entity.
The provider shall not hire or retain in any capacity any person who may directly provide services to a member under this section if that person has a record of:
Employment of individuals with records of such convictions more than five (5) years prior to the time of the background check is a matter within the provider's discretion after consideration of the individual's criminal record in relation to the nature of the position. The member receiving services must be prior notified and approve the receipt of services from such staff in writing if the provider decides to hire a staff person with a conviction.
The provider shall contact child and adult protective services (including the Office of Aging and Disability Services) units within DHHS, within the parameters of current applicable state and federal law, to obtain any record of substantiated allegations of abuse, neglect or exploitation against an employment applicant before hiring the same. In the case of a child or adult protective services investigation substantiating abuse, neglect or exploitation by a prospective employee of the provider, it is the provider's responsibility to decide what hiring action to take in response to that substantiation, while acting in accordance with licensing standards.
18.10-10 Informed Consent Policy
Providers must put in place and implement an informed consent policy approved by the Department. For the purposes of this requirement, informed consent means consent obtained in writing from a member or the member's legally authorized representative for a specific treatment, intervention or service, following disclosure of information adequate to assist the person in making the consent. Such information may include the diagnosis, the nature and purpose of the procedure(s) or service(s) for which consent is sought, all material risks and consequences of the procedure(s) or service(s), an assessment of the likelihood that the procedure(s) or service(s) will accomplish the desired objective(s), any reasonably feasible alternatives for treatment, with the same supporting information as is required regarding the proposed procedure(s) or service(s), and the prognosis if no treatment is provided.
At a minimum, a provider's informed consent policy must ensure that members served by the provider (and their guardians, where applicable) are informed of the risks and benefits of services and the right to refuse or change services or providers.
18.10-11 Reportable Events
Providers shall comply with all terms and conditions of the Department's Regulations Governing Reportable Events, Adult Protective Investigations and Substantiation Hearings. All staff must receive training in mandatory reporting/reportable events before they provide any services under this waiver.
18.10-12 Requirements for Residential Settings Owned or Controlled by a Provider
Where the member receives Home Support Services in a residential setting owned or controlled by the provider, the provider must ensure that the following requirements are met:
These requirements may only be modified where necessary to respond to a specific assessed need. Modifications require clinical documentation supporting the need, and must be identified and justified in the Care Plan.
18.10-13 CARF Accreditation
Where CARF accreditation is required, the provider must either be accredited by the Rehabilitation Accreditation Commission (CARF) to provide brain injury rehabilitation services (other than vocational services, which are not covered by MaineCare,) or otherwise have an eighteen (18)-month provisional certification from the Maine Department of Health and Human Services to cover the period the provider is working to secure CARF accreditation. The Department is responsible for determining compliance with the provisional certification standards in Appendix I of this Section. A copy of the Department-issued provisional certification, or evidence of current CARF accreditation, must be on file with the MaineCare Services. Additionally, the provider must also supply the Department with a copy of the current CARF accreditation survey and if applicable, any plans of corrections.
Providers must maintain CARF accreditation to receive MaineCare reimbursement. CARF accreditation is for a specified period of time and requires periodic review and approval. To maintain accreditation beyond the expiration date, a provider must be resurveyed by CARF by the expiration date or be in the process of a resurvey by the expiration date. Evidence that the resurvey visit has been scheduled can indicate that the resurvey process is underway, as long as the visit was scheduled prior to the expiration date. MaineCare reimbursement will be subject to recoupment, back to the day on which accreditation expired, if CARF accreditation is denied. The facility must provide to the office listed below written evidence of the scheduled CARF survey visit. Evidence of current CARF accreditation, upon receipt, must also be submitted to this office:
Provider File Unit
MaineCare Services
11 State House Station
Augusta, ME 04333-0011
AND
Office of Aging and Disability Services-Brain Injury Services
11 State House Station
Augusta, ME 04333-0011
Each provider requiring CARF accreditation must have a written agreement for services with a clinical director, or shall employ a physician, a neuropsychologist, and other professional personnel to assure appropriate supervision, medical review, and approval of services provided. The clinical director must have responsibility for the overall management of the service and have two (2) years' experience in the rehabilitation of individuals with brain injury, as well as have management and specific training that will enable the director tounderstand and respond to the unique needs of individuals with brain injuries. The clinical director must be actively involved in the service and provide oversight for day-to-day operations.
If a Provider plans to add a new Brain Injury service component that will require additional CARF accreditation (CARF requires new services to be delivered for at least six (6) months prior to a survey visit), the provider may receive MaineCare reimbursement for these new services while working toward CARF survey and certification, so long as the Department is notified in writing at least two (2) months in advance of the intent to seek CARF certification and the date services will start. Additionally, the CARF survey visit must be scheduled prior to the end of the six (6) month period, i. e. a survey visit must be scheduled, not necessarily completed, and the Department notified in writing of the CARF survey appointment date. Reimbursement for the new service component will be subject to recoupment, back to start date of the new services, if CARF accreditation is denied.
18.10-14 General Requirements for Services Requiring CBIS or equivalent
All staff will have expertise in brain injury rehabilitation as demonstrated by achieving the Certified Brain Injury Specialist (CBIS) designation from the Academy of Certified Brain Injury Specialists (ACBIS) or demonstrating competency through an approved equivalent training program supervised by the provider. New staff will achieve CBIS or demonstrate equivalent competency within twelve (12) months from date of hire.
If an equivalent training program is used, the provider must submit documentation and receive approval from the Department (Brain Injury Services) for this program. The provider must demonstrate the equivalency of its alternate training and evaluation methods used to determine the staff member's competence in brain injury rehabilitation.
The provider will submit a detailed curriculum, training and evaluation plan to the Department for review and approval prior to implementation of an equivalent training program. The provider must seek reevaluation of equivalent training programs from the Department on an annual basis. Documentation of plan approval and results of all training and evaluation of staff will be maintained by the provider for Department inspection. Equivalent training programs will be evaluated and approved by the Department based on the following:
A roster of provider staff, their CBIS (or equivalent) status, date of hire, and professional license status (type, number & standing) if applicable, will be submitted to the Department (Brain Injury Services) annually.
