Current through 2024-38, September 18, 2024
To provide services under this section a provider must be
a Qualified Vendor as approved by OADS 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 OADS.
providers must ensure staff are trained in identifying risks, such as risk of
abuse, neglect, or exploitation; participating in a Member's risk assessment;
identifying and reporting to an immediate supervisor changes in health status
and behavior; anticipating or preventing unsafe or destructive behavior; and
safely intervening against undesirable behavior according to an intervention
plan. Any intervention must be consistent with the DHHS's rule governing
Behavioral Support, Modification and Management for People with Intellectual
Disabilities or Autism (14-197 C.M.R. ch 5). It may also be necessary to seek
emergency medical or safety assistance when needed and comply with reporting
requirements outlined in DHHS's Reportable Events System (14-197 C.M.R. ch 12)
and/or Adult Protective Services System (10-149 C.M.R. ch 1).
21.10-1
Direct Support Professional
(DSP)
The following requirements apply to DSPs:
A. DSPs must successfully complete the Direct
Support Professional curriculum as adopted by DHHS, or demonstrated proficiency
through DHHS's approved Assessment of Prior Learning, or has successfully
completed the Maine College of Direct Support within six (6) months of date of
hire.
a. Prior to providing services to a
Member alone, a DSP must complete the following four modules from the College
of Direct Support, including computer based and live sessions:
1. Introduction to Developmental
Disabilities
2.
Professionalism
3. Individual
Rights and Choice
4. Maltreatment
b. Documentation of
completion must be retained in the personnel record.
B. DSPs must complete the following
Department-approved trainings, within the first six (6) months from date of
hire and thereafter every thirty-six (36) months;
1. Reportable Events System (14-197 C.M.R. ch
12) and Adult Protective Services System (14-197 C.M.R. ch. 12)
2. Regulations Governing Behavioral Support,
Modification and Management for People with Intellectual Disabilities or Autism
in Maine (14-197 C.M.R. ch. 5)
3.
Rights and Basic Protections of a Person with an Intellectual Disability or
Autism (
34-B
M.R.S. §5605) .
4. DSPs, regardless of capacity and prior to
provision of service to a Member, must be trained upon hire and annually
thereafter on the Global HCBS Waiver Person Centered Planning and Settings
Rule, Maine Care Benefits Manual, Chapter 1, Section
6;
C. DSPs must have a
background check consistent with Section 21.10-10;
D. DSPs must have an adult protective and
child protective record check;
E.
DSPs must be at least eighteen (18) years of age;
F. DSPs must have graduated from high school
or acquired a GED;
G. DSPs must
have current CPR and First Aid Certification;
H. A DSP is legally authorized to assist with
the administration of medication if the DSP is certified as a Certified Nursing
Assistant-Medications (CNA-M); as a Certified Residential Medication Aide
(CRMA), or a Registered Nurse (RN), or otherwise has been trained to administer
medications through a training program specifically for Family-Centered or
Shared Living model homes and authorized, certified, or approved by
DHHS;
I. A DSP who also provides
Work Support- Individual or Work Support-Group must have completed the
additional employment modules in the Maine College of Direct Support in order
to provide services;
J. A DSP who
also provides Career Planning must successfully complete Maine's "Direct
Support Professional Curriculum," or the "Maine College of Direct Support"
program and additional employment modules, or the College of Employment
Services Certificate, as follows:
a.
Employment Specialist National (ACRE approved) Certification may be substituted
for CDS and employment modules as it is a higher level of staff
certification;
b. Additional 12
hours of Career Planning and Discovery provided through Maine's Workforce
Development System (
www.employmentformewds.org) for either
the Direct Support Professional or the Employment Specialist;
c. An additional 6 hours annually of DHHS
approved continuing education;
K. A DSP who provides Employment Specialist
Services must hold a Certificate of completion of State of Maine Employment
Curriculum for Employment Support Personnel and successfully complete Maine's
"Direct Support Professional Curriculum" or the "Maine College of Direct
Support" program and additional employment modules;
a. Employment Specialist National (ACRE
approved) Certification may be substituted for CDS and employment modules as it
is a higher level of staff certification;
L. A DSP who provides Crisis Intervention
Services must have behavioral intervention training on approved behavioral
interventions procedures (e.g., MANDT);
M. All new staff or subcontractors must
complete the Maine College of Direct Support within six (6) months of actual
employment, calculated from their date of hire. Evidence of date of hire and
enrollment in the training must be documented in writing in the employee's
personnel file or a file for the subcontractor. Services provided during this
time are reimbursable as long as the documentation exists in the personnel
file;
N. A person who provides
Direct Support must be a DSP regardless of his or her status as an employee or
subcontractor of an agency; and
O.
A DSP can supervise another DSP.
21.10-2
Assistive Technology
Assessment: In order to provide an Assistive Technology Assessment, an
enrolled provider must possess the following qualifications (Either A or B).
A.
License Requirements
1. Occupational Therapist or;
B.
Certificate Requirements
A Direct Support Professional (DSP) must be certified as
a:
1. Rehabilitation Engineering
Technologist (RET) or;
2. Assistive
Technology Professional (ATP) from the Rehabilitation Engineering and Assistive
Technology Society of North American (RESNA).
21.10-3
A Crisis Assessment Team
is a team of clinicians convened to provide Crisis Assessment Services. The
team may include, but is not limited to, any or all of the following, if
licensed or certified to practice within their profession:
A. Neuropsychiatrist or psychiatrist, who has
worked with persons with developmental disabilities as a primary part of their
practice;
B. Psychologist or
behaviorist who has worked with persons with developmental disabilities as a
primary part of their practice;
C.
Clinic liaison person, having a bachelor's degree or a nursing degree; direct
experience with persons with developmental disabilities; and extensive
experiences that provide a working knowledge of medical, psychiatric, and
behavioral perspectives;
D. General
medical practitioner;
E.
Occupational therapist;
F. Physical
therapist; or
G. Speech
therapist.
21.10-4
An Employment Specialist is a person who provides Employment
Services or Work Support and has:
A.
Successfully completed an Employment Specialist Certification program as
approved by DHHS within six months of date of hire; approved courses are listed
at:
http://www.employmentforme.org/providers/crp-training.htmlB. Supervision during the first six months of
hire from a Certified Employment Specialist;
C. Received certification as an Employment
Specialist or completed the approved Direct Support Curriculum along with
additional modules specific to employment;
D. Graduated from high school or acquired a
GED;
E. Had a background check
consistent with Section 21.10-10; and
F. Worked for a minimum of one (1) year with
a person or persons having an Intellectual Disability or Autism Spectrum
Disorder in a work setting.
G. An
Employment Specialist who also provides Career Planning must have completed the
additional twelve (12) hours of Career Planning and Discovery provided through
Maine's Workforce Development System and six (6) hours of Department approved
continued education every twelve (12) months.
21.10-5
Phase-Out of Family-Centered
Support
DHHS is discontinuing the Family-Centered Support
service. If a bed becomes vacant in a Family-Centered Support home, that
vacancy may be filled.
Existing Family-Centered Support providers must meet all
the requirements of a Direct Support Professional as set forth in these
rules.
Effective with this rule, no new licenses or license
transfers for Family-Centered Support homes will be approved.
Providers of Family-Centered Support shall not transfer,
in whole or in part, ownership, management, or responsibility for day-to-day
operations of the Family-Centered Support home to another individual or entity.
DHHS will not authorize Family-Centered Support services under a new
license.
21.10-6
Residential Vacancies in Two-Person Homes
A. On the next business day, from the time of
vacancy, the provider shall provide notice of the vacancy to the responsible
OADS Resource Coordinator and the Case Managers for both the departing and
remaining Members.
B. No later than
three (3) business days from the time of vacancy, the provider shall submit a
new proposed staffing pattern for the home that adjusts for the vacancy and is
sufficient to maintain the remaining Member's safety.
C. If the vacancy is the result of
hospitalization, the provider may hold the vacant bed for the hospitalized
Member for a period of thirty (30) calendar days. If, after thirty calendar
days, there is no imminent plan for the
hospitalized Member to return to his or her home, the
provider shall issue a thirty-day (30) discharge notice to the hospitalized
Member, his or her guardian, and DHHS and proceed with the steps below.
D. If the provider determines that
the remaining Member cannot be safely served in the current residence with a
new housemate, the provider shall issue a thirty-day discharge notice to the
remaining Member and DHHS within five (5) business days of the vacancy (or,
where the vacancy results from hospitalization, from the passage of thirty days
from the time of hospitalization).
E. If the provider determines that the
remaining Member can be safely served in the current residence with a new
housemate, the provider and DHHS shall attempt to identify another Member to
fill the vacancy.
1.
Ninety-Day
Letter: If no suitable candidate to fill the vacancy has been found
after ninety calendar days from the date of vacancy (or, where the vacancy
results from hospitalization, from the passage of thirty days from the time of
hospitalization), the provider shall send a letter to the remaining Member and
his or her guardian, where applicable, stating that no suitable housemate has
been located and that the Member should consider looking for other residential
options within or outside the provider agency. The letter shall state clearly
that, should the provider be unable to fill the vacancy within thirty (30) days
of the letter, the provider will issue a thirty-day discharge notice.
2.
Thirty-Day Discharge Notice:
If no suitable candidate to fill the vacancy has been found after thirty (30)
calendar days from the mailing of the ninety-day (90) letter, the provider
shall issue a thirty-day (30) discharge notice to the Member, his or her
guardian, where applicable, and DHHS. The provider shall cooperate with the
Member's planning team in developing a transition plan for the Member to move
to other housing, whether permanent or interim, within thirty (30) days.
Should the provider fail to meet the obligations set
forth above, DHHS may suspend reimbursement to the provider for the remaining
Member's Home Support.
21.10-7
Shared Living (Foster Care,
Adult)
The Shared Living Provider must be a Certified Direct
Support Professional (DSP) who has met all the requirements to provide this
service. The Shared Living Provider must enter into a contractual relationship
with the Administrative Oversight Agency in order to provide services to a
Member. The agency supports the provider in fulfilling the requirements and
obligations agreed upon by the DHHS, the Administrative Oversight Agency, and
the Member's Planning Team as documented in the Member's Person-Centered
Service Plan.
21.10-8
Additional Requirement of MaineCare Provider Participation
All Section
21 Providers must comply with all
applicable federal and state law, including applicable Maine licensing laws and
regulations. Chapter I, Section 1 of the MaineCare Benefits
Manual requires that MaineCare providers must maintain current
licenses, as applicable, and must submit copies of license renewals to the OMS
Provider Enrollment Unit.
21.10-9
Electronic Visit Verification
(EVV)
Every provider of Home Support-Quarter Hour services
must comply with Maine DHHS Electronic Visit Verification ("EVV") system
standards and requirements. In compliance with Section 12006 of the 21st
Century CURES Act (
P.L.
114-255), as codified in
42 U.S.C. §
1396b(l)(1), visits
conducted as part of such services must be electronically verified with respect
to: the type of service performed; the individual receiving the service; the
date of the service; the location of the service delivery; the individual
providing the service; and the time the service begins and ends. Providers may
utilize the Maine DHHS EVV system at no cost, or may procure and utilize their
own EVV system, so long as data from their own or a third party EVV system can
be accepted and integrated with the Maine DHHS EVV system.
21.10-10
Background Check
Criteria
The provider must conduct background checks every two
(2) years on all prospective employees, persons contracted or hired,
consultants, volunteers, students, and other persons who maybe providing Direct
Support Services under this Section. A background check is required for any
adult who may be providing direct or indirect services where the Member
receives Shared Living or Family-Centered Support. Background checks are
required for any adult residing in a Family-Centered or Shared Living Home.
Background checks on persons professionally licensed by the State of Maine will
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:
A. any criminal conviction that involves
abuse, neglect or exploitation;
B.
any criminal conviction in connection to intentional or knowing conduct that
caused, threatened, solicited or created the substantial risk of bodily injury
to another person;
C. any criminal
conviction resulting from a sexual act, contact, touching or solicitation in
connection to any victim;
D. any
other criminal conviction, classified as Class A, B or C or the equivalent of
any of these, or any reckless conduct that caused, threatened, solicited or
created the substantial risk of bodily injury to another person within the
preceding two (2) years; or
E. a
habitual offender status under
29-A M.R.S.
§2551-A.
The provider shall contact child and adult protective
services (including OADS and the Office of Child and Family Services) units
within State government 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. All staff and all adults residing with a Member must have
all background checks completed. All background checks must be completed every
twenty-four (24) months thereafter. Costs for background checks are the
provider's responsibility.
21.10-11
Emergency Intervention and
Behavioral Treatment
A provider must follow DHHS's rule governing emergency
intervention and behavioral treatment for persons with Intellectual
Disabilities (14-197 C.M.R. ch. 5), and training on approved behavioral
interventions procedures (e.g., Mandt) if applicable and indicated as a need in
the Member's PCSP.
21.10-12
Informed Consent Policy
Providers must put in place and implement an informed
consent policy approved by DHHS. For the purposes of this requirement, informed
consent means consent obtained in writing from a person or the person'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.
21.10-13
Rights,
Reportable Events, and Behavioral Support Training
Providers shall comply with all terms and conditions as
described in:
a. Reportable Events
System (14-197 C.M.R. ch. 12); and
b. Adult Protective Services System (10-149
C.M.R. ch. 1); and
c. Regulations
Governing Behavioral Support, Modification and Management for People with
Intellectual Disabilities or Autism in Maine (14-197 C.M.R. ch. 5);
and
d. Rights and Basic Protections
of a Person with an Intellectual Disability or Autism (
34-B
M.R.S. §5605) .
As such, providers will ensure that staff members
receive Department-sponsored training regarding all the regulations listed
above (items a. through d.). Ideally, newly hired staff will receive training
in advance of working with any Member or, at the latest, within six (6) months
of being hired and every thirty-six (36) months thereafter. Providers will
maintain documentation of all training within individual personnel files,
regardless of the staff member's length of employment.
21.10-14
Plan of Corrective
Action (POCA)
A. Notice of Deficiency:
The Department may issue a written notice of deficiency to a provider. The
Notice of Deficiency will describe each deficiency with specificity, and will
identify any regulation (including Ch. II, Sec.
21 Appendix V), policy, or
statutory requirement with which the Department alleges the provider is not in
compliance. The Notice of Deficiency may state that the provider is required to
submit a Plan of Corrective Action to the Department, as described below.
B. Plan of Corrective Action
(POCA): Within 30 days after receiving notification of any deficiency,
including a deficiency with respect to the requirements of Appendix V, a
provider must submit a Plan of Corrective Action (POCA) for approval by the
Department. The Department will approve, reject, or suggest changes to, the
POCA, in writing. If the Department rejects a POCA, the written notice of
rejection will explain the reason(s) why the POCA is being rejected, and may
suggest changes to the POCA.
C. The
POCA must meet the following requirements:
(1) The POCA must be a specific plan which
describes how the deficient circumstance(s) (event, incident, or risk) will be
corrected, including the actions which will be taken to bring about correction.
(2) The POCA must address
correction of the specific deficient circumstance(s) cited. In those instances
where the deficiency resulted from a previously missed time frame, the plan
must include an immediate correction of the deficient circumstance(s) even
though the required time frame has been missed.
(3) The POCA must address all identified
areas where the correction of all related deficient circumstances would be
implemented as specific deficiencies cited may not represent all instances
within the site/service where the practice is deficient. It is, therefore, the
provider's responsibility to identify and correct the deficiency throughout the
site/service.
(4) The POCA must
identify actions steps to prevent the deficient circumstance(s) from
recurring/occurring. When monitoring systems are to be implemented, the plan
will include the type of monitoring, detail for implementation, as well as the
responsible party/entity.
(5) The
POCA must clearly delineate the frequency each element of the plan is to occur.
Such terms as "frequently," "periodically," "as needed" and "ongoing" lack the
necessary specificity to be acceptable.
(6) The POCA must identify by title the
individual(s) responsible for the implementation and monitoring of the plan.
The individuals identified must be employed by the provider.
(7) The POCA must provide date(s), to run
from the date of Department approval of the POCA, by which all components of
the plan will be implemented, and the corrections completed. The length of time
to correct the deficiency specified by the POCA must be as soon as possible.
(8) The POCA should not duplicate
or closely parallel a previously submitted failed plan.
D. Notice of Corrections: When the provider
has successfully completed and complied with the POCA, the agency will issue
written notice to the Department. The Notice of Correction document will
address each deficiency that was listed in the Notice of Deficiency, and
explain, in writing, how the provider complied with the POCA to resolve each
deficiency.
Provider Appeals: Providers can appeal a Notice of
Deficiency within 60 days of receipt of the Notice.
