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.
