Clinicians: There must be written evidence from the appropriate governing body that all Clinicians are conditionally, temporarily, or fully licensed and approved to practice. All Clinicians must provide services only to the extent permitted by licensure. Clinicians are required to follow professional licensing requirements, including documentation of clinical credentials.
Other Qualified Staff: consist of a certified Mental Health Rehabilitation Technician (MHRT), a certified Behavioral Health Professional (BHP), a certified FFT therapist, or a certified MST therapist for the purposes of providing 65.05-9 Children's Home and Community Based Treatment certified by DHHS at the level appropriate for the services being delivered.
A provider may be reimbursed for covered services only if they are provided by Clinicians or other qualified staff.
A DSP is a person who:
Prior to providing services to a member alone, a DSP must have completed the following four modules from the College of Direct Support, including computer based and live sessions:
Documentation of completion must be retained in the personnel record.
All new staff or subcontractors shall have six (6) months from their date of hire to obtain DSP certification. Evidence of date of hire and enrollment in the training must be documented in writing in the employee's personnel file or a file for the subcontractor.
Services provided during this time are reimbursable as long as the documentation exists in the personnel file.
A person who provides Direct Support must be a DSP regardless of his or her status as an employee or subcontractor of a provider.
A DSP can supervise another DSP.
Services for members who are deaf or hard of hearing must be delivered by a provider or an interpreter who is credentialed in the communication mode of the member, whether that is American Sign Language, Oral Interpreter, Cued Speech, or some other communication mode used by deaf, hard of hearing, or non-verbal member.
A member's record must contain written documentation of a Comprehensive Assessment, an Individualized Treatment Plan and progress notes. The Comprehensive Assessment process determines the intensity and frequency of Medically Necessary Services and includes utilization of instruments as may be approved or required by DHHS. Individualized Treatment Plans are the plans of care developed by the Clinician or the treatment team with the member and in consultation with the Parent or guardian, if appropriate, based on a Comprehensive Assessment of the member. Individualized plans include the Individualized Treatment Plan, the Crisis The Comprehensive Assessment must contain documentation of the member's current status, history, strengths and needs in the following domains: personal, Family, social, emotional, psychiatric, psychological, medical, drug and alcohol (including screening for Co-occurring Services), legal, housing, financial, vocational, educational, leisure/recreation, potential need for crisis intervention, physical/sexual and emotional abuse. The Comprehensive Assessment may also contain documentation of developmental history, sources of support that may assist the member to sustain treatment outcomes including natural and community resources and state and federal entitlement programs, physical and environmental barriers to treatment and current medications. Domains addressed must be clinically pertinent to the service being provided. Additionally, for a Comprehensive Assessment for a member with substance use, the documentation must also contain age of onset of alcohol and drug use, duration, patterns and consequences of use, Family usage, types and response to previous treatment. Comprehensive Assessments must be updated before treatment begins if, in the opinion of the professional staff assigned to the case, this would result in more effective treatment. If an update is necessary, additional units for the Comprehensive Assessment may be authorized by DHHS or an Authorized Entity. The Crisis/Safety Plan for Children's Home and Community Based Treatment must address the safety of the member and others surrounding a member experiencing a crisis. The plan must: Providers must maintain written progress notes for all services, in chronological order. All entries in the progress note must include the service provided, the provider's signature and credentials, the date on which the service was provided, the duration (including the beginning and end time) of the service, and the progress the member is making toward attaining the goals or outcomes identified in the ITP. For in-home services, the progress note must also contain the time the provider arrived and left. Additionally, the provider must ask the member or an adult responsible for the member to sign off on a time slip or other documentation documenting the date, time of arrival, and time of departure of the provider. In the case of co-therapists providing group psychotherapy, the provider who bills for the service for a specific member is responsible for maintaining records and signing entries for that member. Facsimile signatures will be considered valid by DHHS if in accordance with mental health licensing standards. Separate clinical records must be maintained for all members receiving group psychotherapy services. The records must not identify any other member or confidential information of another member. For crisis services, the progress note must describe the intervention, the nature of the problem requiring intervention, and how the goal of stabilization will be attempted, in lieu of an ITP. 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.). Documentation of cases where a member requires more than two (2) hours of outpatient services per week to prevent hospitalization must be included in the file. This documentation must be signed by the supervising Clinician. A closing summary shall be signed, credentialed and dated and included in the clinical record at the time of discharge. This will include a summary of the treatment, to include any after care or support services recommended and outcome in relation to the ITP. Periodic review of cases to assure quality and appropriateness of care will be conducted in accordance with the quality assurance (QA) protocols established by DHHS. Reviews will be in writing, signed and dated by the reviewers, and included in the member's record, or kept in a separate and distinct file parallel to the member's record.
Program Integrity Unit requirements apply as defined in the MaineCare Benefits Manual, Chapter I, Section 1, "General Administrative Policies and Procedures".
If the member with a Serious and Persistent Mental Illness is receiving Behavioral Health services reimbursed under Section 65 identified in the member's Individualized Treatment Plan, then the provider must:
Behavioral Health Services providers must conduct background checks every five (5) years on all prospective and current employees, persons contracted or hired, consultants, volunteers, students, and other persons who may be providing direct support services under this Section. Background checks on persons professionally licensed by the State of Maine will include a confirmation that the licensee is in good standing with the appropriate licensing board or entity.
The provider shall contact Child and adult protective services (including OADS and the Office of Child and Family Services) units within State government to obtain any record of substantiated allegations of abuse, neglect, or exploitation against an employment applicant before hiring the same. The provider shall follow the requirements set forth in 22 M.R.S. Ch. 1961, The Maine Background Check Center Act, and 10-144 C.M.R. Ch. 60, Maine Background Check Center Rule, for requirements on conducting and evaluating employee background checks.
All background checks must be completed every five (5) years thereafter in accordance with 10-144 C.M.R. Ch. 60. Costs for background checks are the provider's responsibility.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-65, subsec. 144-101-II-65.08