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-31 - Federally Qualified Health Center Services
Subsection 144-101-II-31.06 - POLICIES AND PROCEDURES

Universal Citation: 10 ME Code Rules § 144-101-II-31.06

Current through 2025-13, March 26, 2025

31.06-1 Professional and Other Qualified Staff

In order for a Federally Qualified Health Center to receive reimbursement, its professional staff must be conditionally, temporarily or fully licensed, in the statewhere services are provided, as documented by written evidence from the appropriate governing body, including: physicians, podiatrists, physician assistants, advanced practice registered nurses, clinical psychologists, clinical social workers, clinical professional counselors, registered nurses, licensed practical nurses, respiratory therapists, dentists, independent practice dental hygienists (effective October 1, 2013, subject to approval by CMS), and dental hygienists. Other qualified staff include: dental externs (added effective July 1, 2013) and dental residents (added effective July 1, 2013) as defined in the MaineCare Benefits Manual, Chapter II - Section 25: Dental Services, who must have a current permit from the Maine Board of Dental Examiners. MaineCare will also reimburse for advanced practice or registered nurses who hold a current, unencumbered compact license from another compact state that they claim as their legal residence. Qualifications of any other staff must be provided and billed in accordance with all other applicable sections of the MaineCare Benefits Manual.

31.06-2 Supervision by a Physician or Other Licensed Practitioner

Medical services rendered under this policy must be provided under the supervision of a physician, or other suitably licensed practitioner, to the extent required by applicable statelaws or regulations. Clinical psychologists, LCSWs, LCPCs, dentists, and other non-medical staff are not subject to the supervision of the physician.

Physician supervision must be performed in accordance with the Maine Board of Licensure in Medicine or the Maine Board of Licensure in Osteopathy requirements. Dental services rendered under this policy must be performed in accordance with the Maine Board of Dental Examiners requirements.

31.06-3 Member Records

There shall be a specific record for each member, which shall include, but not necessarily be limited to:

A. the member's name, address and birth date;

B. the member's social and medical history, as appropriate;

C. a description of the findings from the physical examination;

D. long- and short-range goals, as appropriate, except for clinical psychologist, licensed clinical social worker and licensed clinical professional counselor services, where a mental health treatment plan containing long- and short-term goals and signed by both the provider and the member, must be developed by the third session, and updated with signatures at least quarterly thereafter;

E. a description of any tests ordered and performed and their results;

F. a description of treatment or follow-up care and dates scheduled for revisits;

G. any medications and/or supplies dispensed or prescribed;

H. any recommendations for and referral to other sources of care;

I. the dates on which all services were provided; and

J. written progress notes, which shall identify the services provided and progress toward achievement of goals.

K. for members with a history of chronic mental illness, who receive ongoing outpatient therapy by LCSWs, LCPCs, psychologists or advanced practice psychiatric nurses, or who receive medication management from advanced practice psychiatric nurses, the following additional record-keeping requirements apply:
1. Initial Assessment/Clinical Evaluation. An initial assessment, which must include a direct encounter with the member, and his/her family if appropriate, shall be performed and included in the member's FQHC record. The assessment must include the member's medical and social history and must include the member's diagnosis and the professional who made the diagnosis and that person's credentials.

2. Individual Treatment/Service Plan. An individual treatment/service plan must be developed by the third mental health visit. This individual treatment/service plan shall be in writing and shall identify mental health treatment needs, and shall delineate all specific services to be provided, the frequency and duration of each service, the mental health personnel who will provide the service, and the goals and/or expected outcomes of each service. Treatment plans must be reviewed and approved by a psychiatrist, physician, psychologist, or licensed clinical social worker, licensed clinical professional counselor or advanced psychiatric and mental health nurse, or a registered nurse certified in the specialized field of mental health within thirty (30) days of entry of the member into mental health treatment.

3. Written treatment or progress notes shall be maintained in chronological order, and shall be made for each mental health visit. These notes shall identify who provided the service, the provider's credentials, on what date the service was provided, its duration, and the progress the member is making toward attaining the goals or outcomes identified in the treatment plan.

4. The clinical record shall also specifically include written information or reports on all medication reviews, medical consultations, psychometric testing, and collateral contacts made on behalf of the member (name, relationship to member, etc.).

5. In cases where FQHC mental health services are needed in excess of two hours per week to prevent hospitalization, documentation must be included in the file and signed by a psychiatrist, physician, psychologist, licensed clinical social worker, licensed clinical professional counselor or psychiatric nurse.

6. Discharge/Closing Summary. A closing summary shall be signed and dated and included in the clinical record of discharge treatment and outcome in relation to the individual treatment/service plan.

7. In the event a member receives group services, there shall be no names of other group participants in the member's record. Entries are required for each service billed and must include the name, credentials, and signature of the service provider. See Chapter I of the MaineCare Benefits Manual for additional record keeping requirements.

31.06-4 Program Integrity

Please see Chapter I of the MaineCare Benefits Manual.

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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