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-29 - Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
Subsection 144-101-II-29.17 - APPENDIX IV- Additional Requirements for Section 29 Providers of Community Support Services, Employment Specialist Services, and Shared Living
Universal Citation: 10 ME Code Rules ยง 144-101-II-29.17
Current through 2024-38, September 18, 2024
Providers must first be approved by OADS and subsequently enroll in MaineCare in order to provide services and be reimbursed under this Benefit.
Prior to approval and thereafter, the provider, any contractor or subcontractor of the provider, or other individuals compensated by the provider for assisting in the care of member(s) shall be subject to site visits and interviews to ensure compliance with federal and state laws and regulations and the operational, health, safety and environmental requirements set forth herein. The provider shall permit OADS representative(s) to visit the member and the member's home and program as often as DHHS deems necessary to assure quality services, including unscheduled visits.
The provider must submit the following to the OADS District Resource Coordinator:
A. Application Form. Initial applications shall be submitted using DHHS forms to the OADS District Resource Coordinator. The initial application shall be signed and dated by the provider owner and the presiding officer of the Governing Body, if applicable.
B. The initial application shall be accompanied by documents described in this section of rule demonstrating compliance with requirements described in the following portions of these rules:
1.
Organizational
Structure
a.
Ownership
i.
Authority. The provider shall
maintain documented evidence of its source(s) of authority to provide services.
Such evidence will include articles of incorporation, corporate charter, or
similar documents.
ii. Records.
Corporations, partnerships, or associations shall maintain records of the
contact information for officers, directors, charters, partnership agreements,
constitutions, articles of association and/or by-laws, as applicable.
b.
Capacity
i.
Professional Qualifications.
Provider shall have written job descriptions for all positions within the
agency. The provider shall acquire and retain evidence to demonstrate that all
persons engaged in the provision of services regulated by the State of Maine,
other applicable government entities, professional associations or similar
bodies are appropriately qualified, certified, and/or licensed.
1. The management shall have related
experience demonstrating competency and experience in the health or human
service setting and remain in good standing of licensure or certification
2. Supervisors of Services,
Employment Specialist Services, or Community Support Services shall be required
to meet all of the requirements of the DSP position.
3.
Copies of contracts. When the
provider manages services delivered by another provider, a documented
cooperative, affiliated service, or subcontracting agreement shall exist. This
agreement shall be updated and renewed at least annually. The provider shall
ensure that services provided through an affiliation agreement or subcontract
complies with these rules and any contractual requirements.
c.
Organization
Chart
i. The provider will outline the
business structure in an organizational chart, identify management, staff and
other individuals compensated by the provider for assisting in the care of
member(s) and illustrating the supervisory responsibilities; include
credentials as required for the service delivery.
2.
Personnel
Management
a.
General Orientation
Program. The provider shall have a written orientation program that is
relevant to the organization as a whole and provided to all new employees,
interns, and volunteers. This orientation shall include, but not be limited to:
i. an overview of the service delivery system
as a whole, including the availability of peer and family supports and other
elements of services;
ii. the
provider's mission, philosophy, clinical services, and therapeutic modalities,
policies, and procedures
iii.
member's right to privacy and confidentiality
iv. safety and emergency procedures general
to the provider;
b.
Position Specific Orientation and Training. The provider shall
have personnel policies that includes a description of the education,
experience, and training required for Direct Support Professionals,
Supervisors, and Program Directors.
The policy shall address any provider requirement for a valid driver's license, personal insurance limitations, computer proficiency, and any specific training specified by the provider and include a component specific to monitoring continued compliance.
The policy should note any requirement that the DSP will receive additional training specific to member(s) needs as addressed in the Personal Plan.
i. The provider shall
provide to all employees, interns, and volunteers, orientation specific to the
duties and responsibility for which they were retained or accepted, and ensure
the appropriate certification and training requirements specified in this rule
and applicable governing regulations which includes but is not limited to the
following:
1. Person Centered Planning
Process as outlined in
42 CFR §
441.303
2. Medication Administration Training
required for all DSPs who assist members with over-the-counter and prescribed
medication
3. Cultural competence
training relevant to the populations served, including: age, gender, race,
religion, culture, and sexual orientation.
3.
Operational Policies and
Procedures
a.
General
Policies. The provider shall maintain policies governing essential
elements of service provision. Policies include and are not limited to:
i.
Behavioral Regulations. The
provider shall comply and ensure that all staff and other individuals
compensated for assisting in the care of member(s) comply with the DHHS'
Regulations Governing Behavioral Support, Modification and Management for
People with Intellectual Disabilities or Autism in Maine, (14-197 CMR Ch.
5.)
ii.
Rights and
Protection. The provider shall comply and ensure that all staff and
other individuals compensated for assisting in the care of member(s) comply
with
34-B
MRSA §5605, Rights and Basic Protections
of a Person with an Intellectual Disability or Autism.
iii.
Reports of Abuse, Neglect or
Exploitation. The provider shall maintain a specific policy and
procedure governing the reporting, recording, and review of allegations of
abuse, neglect, or exploitation of persons receiving services, in accordance
with applicable laws, rules, and regulations, including but not necessarily
limited to the Adult Protective Statute. The provider shall comply and shall
ensure that all staff and other individuals compensated by the provider for
assisting in the care of member(s) comply with DHHS' Regulations Regarding
Reportable Events, Adult Protective Investigations and Substantiation Hearings
Regarding Persons with Mental Retardation and Autism (14-197 CMR Ch. 12,
Regulations Regarding Reportable Events, Adult Protective Investigations and
Substantiation Hearings Regarding Persons with Intellectual Disabilities or
Autism), and state law on reportable events and reports of abuse, neglect, and
exploitation (
22
MRSA §3477, Persons Mandated to Report
Suspected Abuse, Neglect or Exploitation;
34-B
MRSA §5604-A, Duty to Report Incidents;
Adult Protective Services Act and Rights Violations; and
22 MRSA
§3740, et seq.,
Adult Protective Services Act).
iv. The provider shall maintain written
policies and procedures and have reporting forms available at each site where
members are served to ensure compliance with the above-mentioned laws and
regulations governing Reportable Events, Rights and Basic Protections and
Reporting of Abuse, Neglect and Exploitation.
v.
Duration of Care. The
provider shall maintain policies that outline the admission process, discharge
procedures for planned or unplanned termination of services, the referral of
individuals deemed inappropriate or not qualified for a particular program to
other programs to meet the individual's needs, and the mechanisms undertaken to
eliminate wait lists or the justification for having no wait list.
vi.
Medication Management. The
provider shall maintain specific policies and procedures ensuring that any
staff and other individuals compensated for assisting in the care of member(s)
receive appropriate training in and comply with medication administration
protocol that is in accordance with DHHS expectations.
4.
Quality
Management. The provider shall have written policies governing the
development and maintenance of an effective quality management program to
ensure quality service delivery consistent with federal and state laws and
regulations. The program shall:
a. identify
areas determined by the provider to be critical to quality service
provision.
b. describe goals set by
the provider to improve services or service delivery and shall describe
indicators to measure achievement of the goals.
c. include on-going, year-round, regular
activities to measure goal achievement.
d. include a component describing the system
to monitor compliance with federal and state laws and regulations.
i.
Evaluation. The findings of
the quality management process shall be reviewed at least annually by the
provider.
ii.
Plan of
Correction. A finding of deficiency in violation of federal or state
laws or regulations shall be reported to DHHS within a 30-day period and be
accompanied by a Plan of Correction to be deemed acceptable by the
DHHS.
5.
Financial Management
a. The
provider shall make available to DHHS upon request, a federal income tax return
for the year in question, a statement of finances including income statement,
balance sheet, cash flow statement, operations and program budget, and profit
projection.
6.
Environment
a.
Fire and
Safety Inspections. Upon receipt of the completed application, fire and
safety inspections may be conducted by authorized representatives of organized
fire departments, by the State Fire Marshall's office and code enforcement
officers.
i. Fire drills shall be conducted
and documented at least four times per year
ii. Emergency Management Plan shall address
the event of loss of essential services such as electricity, water, and
heat
b.
Structures. The provider shall meet current requirements of the
Americans with Disabilities Act of 1990, the
Rehabilitation Act of 1973, and the Maine Human Rights
Act. New construction, renovation, remodeling or repair shall be in
full compliance with the Americans with Disabilities Act of
1990, the Rehabilitation Act of 1973, and the
Maine Human Rights Act. All structures used in the delivery of
waiver services shall be maintained in good repair, free from danger to the
member's health or safety, and shall be appropriate to the services provided.
The provider shall ensure that:
i. furnishings
and equipment are appropriate to the member's age and physical
conditions,
ii. rooms and areas are
clean, appropriately lit, and adequately heated and ventilated based on the
needs of the members,
iii. the
square footage of rooms (i.e. bathrooms, bedroom, dining areas) are appropriate
and adequate for the level of privacy, purpose of the space and to accommodate
users,
iv. utilities are maintained
in good repair and in a manner consistent with applicable codes,
v. a storage area that shall provide secure
space used for the proper storage of potentially harmful materials (i.e.
chemicals, medications, and firearms).
c.
Integrated Settings. The
setting in which residential. community supports, and employment specialist
services are provided shall be integrated in and support full access to the
greater community to the fullest extent and
i. be one of choice and based on the needs of
the individual as indicated in the member's Personal Plan;
ii. ensure a member's rights of privacy,
dignity and respect and freedom from coercion and restraint;
iii. support opportunities to seek employment
in competitive integrated settings, engage in community life, control personal
resources, optimize autonomy and choice in activities and schedules, facilitate
choice of services and providers, and access to services in the
community;
iv. The providers may
modify programs as needed to comply with HCB settings requirements above or
assist individuals to relocate to compliant settings of choice.
In the event that any provider fails to meet the requirements set forth in this Appendix, DHHS will notify the provider in writing of any remedies needed to bring the provider into full compliance. DHHS also will issue a plan of correction setting forth the timeframes within which the provider's compliance must be achieved. Failure to comply with the plan of correction within the stated timeframes may result in the provider's disenrollment for services and/or any other sanctions penalties allowed under the MaineCare Benefits Manual or other state or federal law.
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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