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-28 - Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations
Subsection 144-101-II-28.08 - POLICIES AND PROCEDURES

Universal Citation: 10 ME Code Rules § 144-101-II-28.08

Current through 2024-38, September 18, 2024

28.08-1 Provider Agency Requirements

All providers of services under this Section must be enrolled and approved as MaineCare providers by the MaineCare Services, and all Providers are subject to all requirements of the MaineCare Benefits Manual, Chapter I and this Section. In addition, non-School Providers must be approved by the Office of Child and Family Services (OCFS), Children's Behavioral Health Services (CBHS).

A. Rehabilitative and Community Support Services for Children with Cognitive Impairments And Functional Limitations Provider Contract All non-School providers must have a current contract with DHHS. The content of this contract must stipulate that the provider will Comply with Rider A specifications including:

1) reporting requirements;

2) service specifications/performance guidelines; and

3) process objectives.

B. Prior Authorization through DHHS or its Authorized Agent must be given prior to the start of all services. Utilization Review will be conducted by DHHS or its Authorized Agent.

C. Telemedicine may be utilized as clinically appropriate, according to the standards described in Chapter I, Section 4 of the MaineCare Benefits Manual.

28.08-2 Staff Requirements

A. Qualification Requirements for Direct Care Staff

1. Direct care staff must meet the following minimum requirements:

- Be at least 18 years of age;

- Have a high school diploma or equivalent;

- All direct care staff must obtain a Behavioral Health Professional(BHP) certification within one (1) year of hire. OR

2. Grandfathering: Staff who are employed at the time this rule goes into effect as direct care professionals in Chapter II, Section 24 are considered qualified to provide this service and must complete BHP certification within one (1) year of the effective date of this rule. Any staff working in the capacity of a BHP must become BHP certified no later than September 28, 2011;

3. Provisional Approval of Providers Staff must begin receiving the Behavioral Health Professional training within thirty (30) days from the date of hire. The provisional candidate must complete the training and obtain certification within one (1) year from the date of hire.

Approvals must be maintained in the agency's personnel file and the length of provisional status documented in the employee's file. Provisional candidates who have not completed certification requirements within one (1) year from the date of hire are not eligible to perform reimbursable services with any provider until certification is complete.

AND

4. Supervision of direct care staff:

Provider agencies must identify qualified professional supervisors for each direct care position. Direct care staff employed full time must be supervised a minimum of four (4) hours per month. Direct care staff employed part time must receive a prorated amount of supervision, with a minimum requirement of one hour per month.

B. Requirements for Supervisors of Direct Care Staff

Supervisors of direct care staff must meet the following professional qualifications:

1. Grandfathering: Staff who are employed at the time this rule goes into effect as a Supervisor to direct care professional in Chapter II, Section 24; or

2. Have a Bachelor's degree in a human services or related field and at least (two) 2 years related experience; or

3. Have a Master's degree in a human services or related field and at least (one) 1 year of related experience; or

4. Be a licensed social worker (LSW) with at least (one) 1 year of related experience; or

5. Be a licensed social worker (LSW) who has attained a related Master's degree; or

6. Be a licensed professional counselor (LPC), licensed clinical professional counselor (LCPC), licensed clinical professional counselor conditional clinical (LCPC-CC), licensed clinical social worker (LCSW), Licensed Masters Social Worker conditional (LMSW-C), a Board Certified Behavior Analyst (BCBA), psychologist, physician, or advanced practice registered nurse; or

7. Be a registered professional nurse with 3 years related experience.

C. Requirements for Behavioral Health Professional providing Specialized Services

1. Grandfathering: Staff who have met training, experience and supervision requirements set forth in Section 28.08-2.A. and 28.08-8-2. Bas of the effective date of these rules and as approved by the Department are grandfathered Behavioral Health Professionals with Specialized Services.

2. Behavioral Health Professional providing Specialized Services must meet all of the certification requirements as stated for the Certification as Behavioral Health Professional or equivalent as determined by the Department and must:

a. Be under the Supervision of a Licensed Psychologist, Board Certified Behavior Analyst or equivalent as determined by the Department, and

b. Be able to demonstrate specific competencies required to provide Specialized Services including but not limited to the basic principles of behavior; and

c. Be able to apply, under the direction of the supervisor, an array of procedures specific to Specialized Services.

3. Supervision of Behavior Health Professional with Specialized Services Endorsement

a. Behavioral Health Professionals with Specialized Services Endorsement employed full time must be supervised a minimum of four (4) hours per month. Behavioral Health Professionals with Specialized Services employed part time must receive a prorated amount of supervision, with a minimum requirement of one (1)hour per month.

*The Department is seeking, and anticipates receiving, approval from CMS for this Section.

Pending approval, these changes will be effective.

D. *Requirements for Board Certified Behavioral Analyst (BCBA)

BCBAs provide the supervision and oversight of Specialized Services to ensure fidelity to the evidence-based model. The following requirements apply to BCBAs:

1. The individual must be a practitioner who is certified as a graduate-level BCBA by the Behavioral Analyst Certification Board; OR

2. a Licensed Psychologist with training and/or education specific to behavioral analytic principles.

28.08-3 Program Integrity

The Program Integrity Unit monitors MaineCare reimbursed treatment services provided and determines the appropriateness and necessity of the services, including duplication of services. All Program Integrity requirements apply as defined in the MaineCare Benefits Manual, Chapter I, "General Administrative Policies and Procedures" for more detail.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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