Section 197-11-08 - PROGRAM RESPONSIBILITIES(A) Consumer Control and Responsibility A
(1) Employment of Personal Assistant. The consumer must control and direct the PA in the selection, hiring, management, training, scheduling, and, when necessary, termination of his or her PA. The consumer shall accept personal responsibility for all of the requirements listed below relating to his or her PA, including: (a) Hiring, training, supervision, and termination of the PA;(b) Establishing work schedules;(c) Carrying out the plan of service as it relates to the PA and using the PA responsibly;(d) Unemployment and workers compensation insurance, unless the consumer has chosen to have this carried out by the AA ; and(e) Maintaining records, which comply with Maine State employment laws.(2) Payroll reports. consumer's shall submit payroll documentation and reports, including W-2 and W-4 forms, as required by the established payroll providers and schedules as determined by the Department, the Authorized Agent, and the Internal Revenue Service.(3) PA Documentation. The consumer must file with the Authorized Agent at least two copies of documents used during the hiring process to determine identification and employment status. Such documents will be those that meet the requirements of the Employment Eligibility Verification Form of the U.S. Department of Justice, commonly known as the I-9 Form.(4) Department Requests.consumer's shall provide all information requested by the Department, including surveys of the program for evaluation and planning purposes.(5) Compliance with Applicable Laws. consumer's shall comply with all federal and state laws relating to child labor and employment relationships, including but not limited to, matters relating to hiring, benefits, conditions of work, and terminations.(6) Notice of Change. consumer's shall notify the Authorized Agent as soon as possible about any of the following matters:(a) Changes in name, address, telephone number, Personal Assistant, amount of PA services needed, guardianship, agent, or designee, if any;(b) Plans to leave the state or actual absences from the State in excess of 183 days during the year;(d) Any institutional stays where assistant services are available to the consumer;(e) Changes in MaineCare eligibility;(f) Changes in the type or amount of assistance services received through another source or program;(g) Changes in need for assistant services including changes in disability, medical condition, or living situation which substantially affect the need for assistant services; and(h) Any other changes in their eligibility as referenced in Section 11.02 E ligibility for Services or Section 11.03 D uration of Services.(7) Personal Assistants Under the Age of Eighteen (18). All Personal Assistants under the age of eighteen (18) must report their age and social security number to the Authorized Agent. Personal Assistants must be at least 16 years of age.(B)Responsibilities of the Department of Health and Human Services(1) Selection of Authorized Agent. To select authorized agencies, the Department of Health and Human Services will request proposals at least every three (3) years by publishing a notice in Maine's major daily newspapers and posting on the Department of Health and Human Services website. The notice will summarize the detailed information available in a request for proposals (RFP) packet and will include the name, address, and telephone number of the person from whom a packet and additional information may be obtained. The packet will describe the specifications for the work to be done. Criteria used in selection of the successful bidder or bidders will include but are not necessarily limited to: (b) Organizational capability;(c) Response to a sample case study;(d) Qualifications of staff;(f) Quality assurance plan;(g) Ability to comply with applicable program policies;(i) Demonstrated experience; and(ii) Understanding of disability and independence issues of consumer's.(2) Other Responsibilities of the Department of Health and Human Services. The Department of Health and Human Services is responsible for:(a) Setting the Maximum Authorized Service amount.(b) Establishing performance standards for contracts with authorized agencies including but not limited to the numbers of consumer's to be assessed and served and allowable costs for administration and direct service.(c) Conducting or arranging for quality assurance reviews that will include record reviews and home visits with CDHBC consumer's.(d) Establishing and maintaining a quality assurance review committee (QARC).(i) The QARC is responsible for:(a) Making recommendations for policy changes to the Department of Health and Human Services;(b) Make recommendations for improving quality of care and outcomes for the consumer. The QARC may review the Department's Quality Assurance data and reports;(c) Meeting as often as necessary, but at least four times annually;(d) Using procedures that ensure consumer confidentiality.(ii) The QARC shall have at least six (6) members. The Department of Health and Human Services is responsible for scheduling, notifying and recruiting new members, and documenting and distributing the meeting minutes and case review summaries to all members. Membership on the QARC must include:1. Program consumer's sufficient in numbers to be a majority of the QARC's members;2. The Assessing Services agency staff;3. Service Authorized Agents;4. A Program Director from the Department of Health and Human Services, or their designee, and5. Staff from the Long Term Care Ombudsman.(e) Providing training and technical assistance.(f) Providing written notification to the authorized agencies regarding strengths, problems, violations, deficiencies or disallowed costs in the program and requiring action plans for corrections.(g) Assuring the continuation of services if the Department of Health and Human Services determines that an authorized agent's contract must be terminated.(h) Administering the program directly in the absence of a suitable authorized agent.(i) Conducting a request for proposals for authorized agents at least every three years thereafter.(j) At least annually, review the randomly selected requests for waivers of consumer payment.(k) Recouping CDHBC funds from authorized agencies when the Department of Health and Human Services determines that funds have been used in a manner inconsistent with these rules or the authorized agent's contract. (l) Review of reimbursement rates. The Director shall review the rates ofreimbursement under the program subject to the provisions of 34-B M.R.S.A. §5438.(C)Authorized Agent Responsibilities(1) The Authorized Agent shall:(a) Employ staff qualified by training and/or experience to perform assigned tasks and meet the applicable licensure requirements.(b) Comply with requirements of 22 M.R.S.A. §3471 et seq. and 22 M.R.S.A. §4011-A - 4017 to report any suspicion of abuse or neglect.(c) Pursue other sources of reimbursement for services prior to the authorization of CDHBC services.(d) Operate and manage the program in accordance with all requirements established by rule or contract.(e) Have sufficient financial resources, other than Federal or State funds, available to cover any CDHBC expenditures that are disallowed as part of the Department of Health and Human Services utilization review process.(f) Inform in writing any consumer with an unresolved complaint regarding their services about how to contact the Long Term Care Ombudsman and the Department.(g) Assure that costs to CDHBC funds for services provided to a consumer in a twelve month period do not exceed the applicable annual service plan cost limit, for which the consumer is determined eligible, established by the Department of Health and Human Services.(h) Implement an internal system to assure the quality and appropriateness of assessments to determine eligibility and authorize service plans including, but not limited to the following: 1. Consumer satisfaction surveys;2. Documentation of all complaints, by any party including any resolution action taken;3. Measures taken by the Authorized Agent to improve services.(i) Participate in the Quality Assurance Review Committee as required by the Department of Health and Human Services.(a) Assure that consumer's receive training on the following: (i) maintaining records which comply with Maine State employment laws;(ii) child labor laws and the appropriate forms to use if employing a PA who is under eighteen (18) years of age;(iii) conducting a background check on possible PAs;(iv) HIPPA confidentiality requirements; and(v) information on advertising, hiring, job descriptions, supervision, management, and scheduling assistants. Travel time to and from the location of the consumer is excluded.
(b) Assure contact with each consumer at least twice in the first six months and at least annually, or more often as deemed appropriate by staff, to verify receipt of authorized services, discuss consumer's status, review any unmet needs and provide appropriate follow-up and referral to community resources.(c) Assure each Consumer's compliance with worker's compensation coverage, unemployment insurance coverage and FICA withholding for employees reimbursed with program funds.(d) Make efforts to make any existing worker's compensation pools available to program consumer's. B (2) Consumer Records and Program Reports.
(a) Content of Consumer Records. The Authorized Agent must establish and maintain a record for each consumer that includes at least:(i) The consumer's name, address, mailing address if different, telephone number, and if available, an email address;(ii) The name, address, and telephone number of someone to contact in an emergency;(iii) Complete medical eligibility determination form and financial assessments and reassessments that include the date they were done and the signature of the person who did them;(iv) A service plan summary that promotes the consumer's independence, matches needs identified by the scores on the MED form, and is authorized by the Authorized Agent in the service plan summary on the MED form, with consideration of other formal and informal services provided and which is reviewed annually. The service plan includes:(a) Evidence of the consumer's participation;(b) Identification of needs;(d) Who will provide what service, when and how often, reimbursed by what funding source, the reason for the service and when it will begin and end;(e) The signature of the assessor who determined eligibility and authorized a plan of service; and(v) A dated release of information signed by the consumer that conforms with applicable law, is renewed annually and that:(a) Is in language the consumer can understand;(b) Names the agency or person authorized to disclose information;(c) Describes the information that may be disclosed;(d) Names the person or agency to whom information may be disclosed;(e) Describes the purpose for which information may be disclosed; and(f) Shows the date the release will expire.(vi) Documentation that consumer's eligible to apply for a waiver for consumer payments, were notified that a waiver may be available;(vii) Evidence that the consumer has certified competency of the PA;(viii) Written progress notes that summarize any contacts made with or about the consumer and: (a) The date and duration of the contact;(b) The name and affiliation of the person(s) contacted or discussed;(c) Any changes needed and the reasons for the changes in the plan of service;(d) The results of any findings of MDT contacts or meetings and, if applicable, of quality assurance review committee (QARC) meetings; and(e) The signature and title of the person making the note and the date the entry was made;(i) Proof of required FICA, Unemployment and Workers Compensation contibution and coverage; and(xi) Documentation of all complaints, by any party, including resolution action taken.(b) Program Reports. The following reports must be submitted to the Department of Health and Human Services, in a format approved by the Department of Health and Human Services, by the day noted:(1) Monthly service and consumer reports including admissions, discharges and active consumer lists, due no later than twenty days after the end of the month;(2) Monthly fiscal reports, due no later than twenty days after the end of the month;(3) Quarterly and annual demographic reports, due no later than twenty five days after the end of the quarter; and(4) Monthly authorizations for CDHBC services, due by the tenth of the month for which authorizations are reported.(5) Monthly reports of the type and number of assessments completed by the authorized agent as required by the contract with the Department of Health and Human Services.14- 197 C.M.R. ch. 11, § 08