Subsection 144-101-II-67.04 - STANDARDS OF CAREAll nursing facilities must meet the following standards to qualify for MaineCare reimbursement:
67.04-1General Regulatory ComplianceA. In order to qualify for reimbursement under this Section, NFs, including those operated by the State of Maine, must meet the requirements contained in the Regulations Governing the Licensing and Functioning of Skilled Nursing Facilities and Nursing Facilities as are currently in effect. NFs must also comply with the Principles of Reimbursement for Nursing Facilities; and all requirements of Title XIX of the Social Security Act and the CFR, Subpart B, Requirements for Long Term Care Facilities, 42 CFR 483 issued pursuant thereto, as are most currently in effect. These standards are incorporated into this Section by reference as if set out fully herein.B. All NFs including those operated by the State of Maine, must obtain a license from the Department of Health and Human Services in order to qualify for Title XIX reimbursement. However, the license shall not be considered valid evidence that the facility meets all requirements for certification under MaineCare regulations if the Secretary of Health and Human Services has established, on the basis of an on-site monitoring survey or other federal review, that the Department's certification agency has failed to properly apply Federal certification standards or procedures.C. Each NF must obtain Medicare certification for a minimum of twenty percent (20%) of its licensed bed capacity. Additionally, any NF that participates in the MaineCare program must follow required Federal procedures for certification and become certified following the Department's recommendation for certification; submit an annual application for Medicare participation at the same time applications for licenses and MaineCare certification are due; and participate in the Medicare program by billing Medicare for care provided to eligible members prior to billing MaineCare.D. Sanctions. Failure to comply with any of the provisions in Section 67.04-1(C) may result in the imposition of a penalty of one hundred dollars ($100) per bed. This penalty must be imposed for each day a NF fails to comply with the requirement that the NF participate in the Medicare program by billing Medicare for care provided to eligible members prior to billing MaineCare. A repeated failure to comply with any provision in Section 67.04-1(C) will result in fines of two hundred dollars ($200) per bed. The imposition and collection of these sanctions are governed by 22 M.R.S.A. §7946.E. In order to qualify for reimbursement for laboratory services by nursing facilities, those laboratory services must be in compliance with the rules implementing the Clinical Laboratory Improvement Amendments (CLIA) of 1988, and any amendments thereto, or otherwise have a waiver. CLIA regulations are located at following website:http://www.phppo.cdc.gov/clia/regs/toc.aspx [File Link Not Available].67.04-2Training Requirements for Alzheimer's and Dementia ServicesNursing facilities that admit members or have members determined eligible based in part on the supplemental dementia screen in Section 67.02-3(C) will be reimbursed with MaineCare funds for those members if the NF can document that it meets the following training standards:
A. The NF must document six (6) hours of classroom training on Alzheimer's and other dementia for all licensed staff, CNA, social work, activities and housekeeping staff In addition, the NF must be able to document six (6) hours of clinical experience for licensed staff, CNA, social work and activities staff In addition, four (4) of the twelve (12) contact hours required for CNA certification in-service must be in the area of managing residents with cognitive impairments.B. Training shall be provided by individuals qualified by education or experience and must include, but is not limited to the following topics: diseases and conditions that cause dementia; behavior management; communication with resident and family; creating a therapeutic environment; promoting functional independence; legal and ethical issues; and mandatory reporting of abuse, neglect and exploitation. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-67, subsec. 144-101-II-67.04