C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-12, subsec. 144-101-II-12.08

Current through 2024-44, October 30, 2024

Subsection 144-101-II-12.08 - POLICIES AND PROCEDURES

12.08-1Electronic Visit Verification (EVV)

Effective January 1, 2020, every provider of Personal Care Services must comply with the Maine DHHS Electronic Visit Verification ("EVV") system for standards and requirements. In compliance with Section 12006 of the 21^st Century CURES Act ( P.L. 114-225 ), as codified in 42 U.S.C. § 1396b(l)(1), visits conducted as part of such services must be electronically verified with respect to: type of the service performed; the individual receiving the service; the date of the service; the location of the service; and the time the service begins and ends. Providers may utilize the Maine DHHS EVV system at no cost, or may procure and utilize their own system, so long as data from the provider owned system can be accepted and integrated with the Maine DHHS EVV system and is otherwise compatible.

12.08-2Professional and Other Qualified Staff

The following professionals are qualified professional staff:

A. Eligibility Determination staff employed by the ASA or the Department must be a registered nurse licensed to practice nursing in the State of Maine.

B. Care Coordination Agency staff providing services under this section shall meet the following qualifications:

1. A registered nurse licensed to practice nursing in the State of Maine;

2. A Registered Occupational Therapist who is licensed to practice occupational therapy in the State of Maine; or

3. A Certified Occupational Therapy Assistant who is licensed to practice occupational therapy in the State of Maine, under the documented supervision of a licensed occupational therapist; or

4. A Licensed social service or health professional; or

5. An individual who has had four years of education in the health or social services field and one year of community experience.

C.Attendant

An attendant must be at least seventeen (17) years old and have the ability to assist with Activities of Daily Living. An attendant cannot be an individual who has a notation on the Maine Registry of Certified Nursing Assistants of (a) any criminal convictions, except for Class D and Class E convictions over ten (10) years old that did not involve as a victim of the act, a patient, client, or resident of a health care entity; or (b) any specific documented findings by the State Survey Agency of abuse, neglect or misappropriation of property of a resident, client or patient.

After the completion of consumer instruction, the member shall train the attendant on the job. Within a twenty-one (21) day probation period, the member will determine the competency of the attendant on the job. At a minimum, based upon the attendant's job performance, the member will certify competence in the following areas:

- ability to follow oral or signed and written instructions and carry out tasks as directed by the member;

- disability awareness;

- use of adaptive and mobility equipment;

- transfers and mobility; and

- ability to assist with health maintenance activities.

Satisfactory performance in the areas above will result in a statement of competency for each attendant. This statement must be signed by the member, submitted to the Service Coordination Agency, and a copy kept in the member's record.

12.08-3Member Appeals

The Department, the ASA and/or Service Coordination Agency must notify the member in writing that he/she has the right to appeal when there has been a denial, termination, suspension or reduction of eligibility for a MaineCare covered service under this Section. In order for services to continue during the appeal process, a request for an appeal must be received by the Department within ten (10) days of the notice to reduce, deny, suspend, or terminate services. Otherwise, a member has sixty (60) days from the date of the notice in which to appeal a decision. Members shall be informed in writing by the ASA or the Service Coordination Agency of their right to request an administrative hearing in accordance with this Section and Chapter I of the MaineCare Benefits Manual. The appeal must be (a) requested in writing and mailed to the address below, or (b) requested by telephone by calling 207-287-9200, or TTY: Toll Free 1-800-262-2232.

Office of Aging and Disability Services

Department of Health and Human Services

11 State House Station

Augusta, ME 04333-0011

12.08-4Member Records

A. The ASA must establish and maintain record for each member that includes at least:

1. The member's name, address, mailing address if different, and telephone number;

2. The name, address, and telephone number of someone to contact in an emergency;

3. Complete assessments including the MED form, (maintained in MECARE for the ASA), with the care plan summary that matches needs identified by the scores and timeframes on the MED form and authorized by the ASA. All assessments and reassessments must include the date they were done and the electronic signature of the person who did them;

4. A dated release of information signed by the member that conforms with applicable state and federal law and is renewed annually.

B. The Service Coordination Agency must establish and maintain a record for each member that includes all items in Section 12.08-3(A) and all items included below:

1. The service plan must indicate the type of services to be provided for each covered ADL, IADL, and health maintenance activity identified in the MED form, and specify the number of hours per week, the tasks, and reasons for the service;

2. Documentation must be provided and available in the member's record of the verification by the member's physician of the chronic or permanent nature of the member's functional disability;

3. Documentation of all contacts between the member and the attendant, including date, services covered, type of contact, and duration; a daily task list of covered services is acceptable, providing it matches the authorized plan of care (Section 7 of the MED form) on the care plan summary of the MED form;

4. Documentation of the entrance and exit times for the personal care attendant and for consumer instruction staff (travel time to and from the location of the member is not covered);

5. Documentation of the results of member instruction and testing;

6. Documentation of ability to self-direct, as documented on the MED form and as required in member instruction and testing;

7. Signed certification(s) of attendant competency;

8. Attendant payroll records, approved timesheets and employment forms;

9. Documentation of all complaints, by any party including resolution action taken;

10. Written progress notes that summarize any contacts made with or about the member and:

(a) The date the contact was made;

(b) The name and affiliation of the person(s) contacted or discussed;

(c) Any changes needed and the reasons for the changes in the service plan; and

(d) The signature and title of the person making the note and the date the entry was made.

Member's records shall be kept current, available to the Department, and retained in conformance with Chapter I. Such records shall be documentation of services included on invoices.

12.08-5Program Integrity

Requirements of Program Integrity are detailed in Chapter I of the MaineCare Benefits Manual.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-12, subsec. 144-101-II-12.08