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-43 - Hospice Services
Subsection 144-101-II-43.06 - DURATION OF CARE
Current through 2024-38, September 18, 2024
43.06-1 Member Service Provision Rights
Receipt of hospice services in no way affects the rights afforded to residents of a nursing facility under Chapter II, Section 67, including those relating to transfer and discharge, status change notification and hearings and appeals.
The election of hospice by a member, however, in no way diminishes the responsibility of the member or nursing facility to obtain required prior authorization, or to comply with eligibility requirements for nursing facility placement.
43.06-2 Member Status Change
This section delineates who is responsible for submitting notification for hospice members who are in a NF.
When the change of status is a transfer from one hospice to another, the hospice to which the member is moving must submit the BMS 34 form.
43.06-3 Professional and Other Qualified Staff
The hospice is responsible for the verification of appropriate licensure, certification or other qualifications of hospice staff, and for monitoring service providers. The hospice must maintain documentation of qualifications of service providers.
Staff must meet orientation and training requirements outlined in hospice licensing regulations.
A CNA or home health aide must be listed on the Maine Registry of Certified Nursing Assistants. A CNA or home health aide must be supervised as required by licensing regulations.
Other qualified staff are staff members, other than those defined above, who have been determined competent by a health care professional and documented by the hospice to have appropriate education, training and experience for the task in the plan of care for which they have been hired.
43.06-4 Written Plan of Care
A plan of care must be established before services are provided. The plan of care must be established by the member's Attending Physician, the hospice physician, and the Interdisciplinary Team. Services must be consistent with the plan of care to be reimbursed. The hospice must designate a registered nurse, whose responsibility it is to coordinate the implementation of the plan, and to provide assurance that the member receives necessary care and services on a 24-hour basis. The plan must be established on the same day as the assessment if the day of assessment is to be a covered day of hospice care.
43.06-5 Member Record
All hospices must maintain a clinical record for each member receiving care and services. The clinical record must include the following information:
43.06-6 Surveillance and Utilization Review
The Department shall perform the Surveillance and Utilization Review activities set forth in Chapter I, General Administrative Policies and Procedures, of the MBM.
Upon request, the provider will furnish to the Department, with no additional charge, the clinical records, or copies thereof, corresponding to and substantiating services billed by that provider.
43.06-7 Electronic Visit Verification
Effective July 1, 2024, all Hospice Services provided in-home are subject to the following requirements:
