Current through 2024-38, September 18, 2024
4.A.
Administrator
4.A.1.
Qualifications
The administrator of a facility licensed pursuant to these
regulations shall have a current administrator's license or a temporary permit
issued by the Nursing Home Administrators Licensing Board. Hospital based
facilities are not required to have a licensed nursing home
administrator.
4.A.2.
Functions
The administrator designated on the license shall be
responsible for:
a. Carrying out the
policies of the facility;
b. The
day-to-day operation and management;
c. The control, conservation and utilization
of physical and financial resources;
d. The hiring of an adequate number of
qualified, competent personnel;
e.
The discharge of such functions as the licensee may properly delegate to
him/her;
f. Ensuring that the
facility is in compliance with State licensing and Federal certification
regulations.
4.A.3.
Non-Licensed Person to Act in Absence of Administrator
An individual, authorized to act in the absence of the
administrator during the normal working day, shall be designated. Any planned
absence of the administrator for a period longer than thirty (30) days shall be
reported in writing to the Department.
4.A.4.
Non-Licensed Acting
Administrator for Emergency Conditions
If the licensee of a licensed skilled nursing facility and/or
a nursing facility is required to secure a new administrator as a result of an
unexpected vacancy, he/she may, upon seventy-two (72) hours notice to the
Department and in accordance with the rules and regulations thereof, place the
facility in charge of an acting administrator qualified through current
experience in administrative long term care responsibilities. This shall be for
such limited time mutually agreed upon between the Department and the licensee,
as may be necessary to permit the securing of a licensed administrator, but in
no event to exceed sixty (60) days. When a licensed administrator has been
secured, the provisions of Section 2. H.6., Change of Administrator, shall
apply. If unable to secure a licensed administrator within sixty (60) days, the
facility shall submit to the Department written evidence of action taken to
secure an administrator.
4.A.5.
Full-Time Administrator
Each nursing facility larger than forty (40) beds in size
shall have a full-time administrator.
4.A.6.
Part-Time Administrator
a. Each nursing facility of forty (40) beds
or less in size, may have a part-time administrator.
b. All duties and schedules of working hours
of part-time administrators of nursing facilities shall be outlined in the
policies of the facility.
4.A.7.
Shared Administrator
a. Separately licensed nursing facilities
and/or assisted living facilities may share the same administrator as long as
the number of beds for which the administrator is responsible does not exceed
one hundred (100), subject to approval of the Department.
b. Requests to the Department for exceptions
to (a) above may be made in writing when administrative functions for two (2)
or more licensed facilities are carried out in a central office. Such requests
shall define the functions being handled centrally. The Department shall
indicate in writing whether or not the request for an exception is
granted.
c. Any sharing of the same
administrator shall be defined and the duties and schedule of working hours for
each facility shall be outlined in the policy material of the facilities
involved.
4.A.8.
Administrator In Training
Any facility that has an administrator in training (AIT) must
ensure that a licensed administrator or designee other than the AIT is in
charge of the facility. No AIT is to be listed on any facility license as the
administrator.
4.B.
Register
4.B.1. There shall be a waiting list for
facility admissions which shall be maintained in a bound book or on a computer,
updated as necessary.
4.B.2. There
shall be a resident admission and discharge register in a bound book or on a
computer identifying each resident and the date admitted to and discharged from
the facility.
4.C.
Daily Census
Each facility shall maintain a daily census of residents,
including the following:
4.C.1.
Admissions;
4.C.2.
Discharges;
4.C.3. The number and
bed locations of each resident in the facility as of midnight each
day.
4.D.
Transfer
Agreement
4.D.1.
Requirements
Each facility shall have in effect a written agreement with a
hospital sufficiently close to the facility to make feasible the transfer
between them of residents and their records, which provides the basis for
effective working arrangements under which inpatient hospital care or other
hospital services are available promptly to the facility's residents when
needed.
4.D.2.
Contenta. The transfer agreement
shall provide for the transfer of written information pertaining to the care
which the resident has been receiving.
b. The transfer agreement shall provide for
the transfer of written information relative to personal effects of significant
value.
4.D.3.
Execution
Each transfer agreement shall be signed by the administrator
or authorized representative of each facility participating in the
agreement.
4.E.
Outside Resources
4.E.1.
Requirements
If the facility does not employ a qualified professional
person such as a physical therapist, occupational therapist or speech therapist
to render a specific service to be provided by the facility, there shall be
arrangements for such a service through a written agreement with an outside
resource, a person or agency, that will render direct service to residents or
act as a consultant.
4.E.2.
Contents of Agreementa. The
responsibilities, functions, objectives, and terms of the agreement, including
financial arrangements and charges, of each such outside resource shall be
delineated in writing
b. The
agreement shall specify that the facility retains administrative responsibility
for the services rendered.
c. When
the agreement is with a consultant, there shall be provision for dated, signed
reports to the administrator of assessments and/or recommendations. These shall
be retained by the administrator for follow-up action and evaluation of
performance.
4.E.3.
Execution
The agreement shall be signed by the administrator or
authorized representative and the person or agency providing the
service.
4.F.
Rebating Prohibited
No owner, administrator, employee or representative of a
licensed facility shall directly or indirectly pay any commission, bonus, or
gratuity in any form whatsoever to any physician, organization, agency or
person for residents referred.
4.G.
Admissions
A facility must establish identical practices for admissions,
transfers and discharges for all individuals regardless of source of payment,
as addressed below.
4.G.1.
Admissions
a. The facility must
not:
1. Require a third party guarantee of
payment to the facility as a condition of admission, or to expedite admission,
or continued stay in the facility;
2. Charge, solicit, accept, or receive, in
addition to any amount otherwise required to be paid under the State plan, any
gift, money, donation, or other consideration as a precondition of admission,
expedited admission or continued stay in the facility;
3. Require residents or potential residents
to waive their rights to Medicare or Medicaid;
4. Require oral or written assurance that
residents or potential residents are not eligible for, or will not apply for,
Medicare or Medicaid benefits.
b. A facility may:
1. Charge any amount for services furnished
to non-Medicaid residents consistent with the requirement in 4.G.1.a.
2. Require an individual who has legal access
to a resident's income or resources available to pay for facility care, to sign
a contract, or to provide facility payment from the resident's income or
resources, without incurring personal financial liability.
3. Charge a resident who is eligible for
Medicaid for items and services the resident has requested and received, and
that are not specified in the Maine Medical Assistance Manual as included in
the term "nursing facility services".
4. Solicit, accept or receive a charitable,
religious, or philanthropic contribution from an organization or from a person
unrelated to the resident, or potential resident, but only to the extent that
the contribution is not a condition of admission, expedited admission, or
continued stay in the facility.
5.
A nursing facility may decline to admit a prospective resident after an
evaluation of the person's clinical condition and related care needs and a
determination that the facility lacks qualified staff to meet the level of care
required for that person. A nursing facility is not subject to penalty or
sanction for declining to admit a prospective resident for whom the facility
lacks sufficient staff to meet the resident's level of care.
4.G.2.
Deceased
Residents
A facility shall comply with all appropriate Maine statutes
and regulations pertinent to deceased residents.
4.H.
Quality Assurance Committee
All nursing facilities must maintain a quality assurance
committee, which may act as a committee of the whole, and which reports to the
administrator or the Governing Body.
4.H.1.
Composition of Committee
a. The Director of Nursing
Services;
b. The Medical
Director;
c. A
Pharmacist;
d. At least three (3)
other members of the facility staff.
4.H.2.
Responsibilities of the
Committeea. Meet at least
quarterly;
b. Monitor the quality,
quantity and necessity of services. Identify and document problems or
deficiencies.
c. Develop and
implement appropriate plans of action to correct identified problems or
deficiencies which shall be available for review upon request of the
Department.
4.H.3.
Components and Functions of the Committee
a. Infection Control
1. Assure policies and procedures are based
upon current standards and Centers for Disease Control guidelines for:
a. Prevention of infection;
b. Universal precautions;
c. Employee and resident
infections;
d. Linen
handling;
e. Food handling;
2. Monitor and
investigate infections.
b. Accident Prevention
Monitor and analyze incident reports and recommend policies
and procedures for accident prevention.
c. Pharmaceutical Services
Monitor pharmaceutical practices, identify concerns, and
recommend changes, when necessary.
d. Utilization Review
Establish and monitor a Utilization Review plan that shall
include:
1. Monitoring of admissions
(regardless of payment source), and necessity of services;
2. Review of all residents (regardless of
payment source), continued stays and discharge planning; and
3. Review the implementation of monitoring of
appeal rights and the process of transfer and discharge notice.
4.I.
Complaints
4.I.1. Any person may
file a complaint with the administrator or any member of the facility
staff.
4.I.2. A system must be
established for the review, within forty-eight (48) hours, of each complaint
received by the administrator and/or any designated member of the facility
staff. A report of findings and action taken shall be prepared and submitted to
the Quality Assurance Committee, and be available for review upon request of
the Department.
4.J.
Reporting of Abuse, Neglect or Misappropriation of Resident
Property
4.J.1. The facility must
ensure that all staff are knowledgeable of the Adult Protective Services Act
and that all alleged violations involving mistreatment, neglect, and abuse,
including injuries of unknown source and/or misappropriation of resident
property, are reported immediately, through established procedures, to the
administrator of the facility and to other officials in accordance with State
law.
4.J.2. The facility must have
evidence that all alleged violations are thoroughly investigated and in a
timely manner. Policies must address administrative procedures to be
implemented to prevent further potential abuse while the investigation is in
progress.
4.J.3. The results of all
investigations conducted in-house must be reported to the administrator or
his/her designated representative and to other officials in accordance with
State law. If the alleged violation is verified, appropriate corrective action
must be taken. All reports must be made available to the Department upon
request.
