14-118 C.M.R. ch. 5, § 16 - Private Non-medical Institutions (PNMI)
16.1.
Provider agreements. All
PNMIs must have a provider agreement that encompasses the MaineCare Provider
Supplier Agreement on file with the Department of Health and Human Services,
Division of Licensing and Regulatory Services. Providers must also contract
with the department and satisfactorily meet all contract and provider agreement
provisions.
16.2.
Compliance
with regulations. A PNMI providing substance abuse services shall comply
with all portions of these regulations in Section 16 (Substance Abuse Treatment
Services) pertaining to the component, module, substance abuse treatment
services, and sites offered by the PNMI.
16.3.
Coordination of PNMI
services. It is the responsibility of the PNMI provider to coordinate
PNMI services with other "in-home" services to address the full range of member
needs. Other MaineCare covered services shall not duplicate PNMI services
included in the facility's PNMI rate. Services that are part of the PNMI rate
may not be billed to MaineCare separately by other providers. For example, if
the PNMI provides personal care services, and a member receives Home and
Community Based Waiver Services, the personal care services shall be delivered
by the PNMI provider and not by a certified nursing assistant (CNA), home
health aide (HHA), or personal care assistant (PCA) as otherwise
allowed.
16.4.
Personal care
staff and services. PNMIs approved and funded by OSA in
licensed/certified facilities may also provide personal care services necessary
for the promotion of ongoing treatment and recovery.
16.4.1. The personal care services provided
by the PNMI are prescribed by a physician upon or within thirty (30) days of
admission, are in accordance with the member's plan of care, are supervised by
a registered nurse at least every ninety (90) days, and are not provided by a
member of the client's family as described in the MaineCare Benefits Manual,
Chapter II, Section 97.01-6 or the pertinent Appendix of the MaineCare Benefits
Manual, Chapter III, Principles of Reimbursement.
16.4.3.1. assistance or supervision of
activities of daily living that could include bathing, dressing, eating,
toileting, ambulation, personal hygiene activities, grooming, and the
performance of incidental household tasks essential to the activities of daily
living and to the maintenance of the member's health and safety within the
substance abuse treatment PNMI;
16.4.3.2. supervision of or assistance with
administration of physician ordered medication;
16.4.3.3. personal supervision or being aware
of the member's general whereabouts, observing or monitoring the member while
on the premises to ensure their health and safety, reminding the member to
carry out activities of daily living, and assisting the member to carry out
activities of daily living, and assisting the member in adjusting to the group
living facility;
16.4.3.4.
arranging transportation and making phone calls for medical or treatment
appointments as recommended by medical providers, or as indicated in the
member's plan of care;
16.4.3.5.
observing and monitoring clients and reporting changes in the client's normal
appearance, behavior, or state of health to medical providers or supervisory
personnel as appropriate;
16.4.3.6.
arranging or providing motivational, diversionary, and behavioral activities
which focus on social interaction to reduce isolation or withdrawal and to
enhance communication and social skills necessary for ongoing treatment and
recovery, as described in the member's plan of care;
16.4.3.7. monitoring and supervising client's
participation in the treatment; and
16.4.3.8. psychosocial services including
assisting clients to adjust to the substance abuse treatment PNMI, to live as
independently as possible, to cope with personal problems during periods of
stress, to accept and adjust to their personal life situations, to accept and
cope with their chemical addictions and to decrease unhealthy behaviors leading
to possible relapse into active addiction, in addition to providing services
and a supportive environment which promotes feelings of safety and freedom from
danger, fear or anxiety as well as services that assist the client to manage
mental health symptoms and behaviors related to co-occurring disorders
.
16.4.2. Alcohol and
drug treatment PNMIs that provide personal care services shall maintain
documentation that each staff member providing such services has received forty
(40) hours of orientation and training in personal care procedures appropriate
to clients. Areas of training must include introduction to chemical addictions,
assistance in self-administration of medicine, infection control, bowel and
bladder care, nutrition, methods of moving clients, co-occurring disorders
training and health oriented record keeping.
16.4.3. Personal care services shall consist
of, but are not limited to, the following:
16.5.
Clinical consultant
services. Clinical consultant services must be provided by licensed or
certified professionals as described in the MaineCare Benefits Manual, Chapter
II, Section 97.07-2, who are working within all State and Federal regulations
specific to the services provided. For substance abuse facilities, clinical
consultants may include substance abuse services including methadone
maintenance services.
16.6.
Surveillance and Utilization Review Services (SURS). A PNMI is
subject to the surveillance and utilization review requirements set out in the
MaineCare Benefits Manual, Chapter I.
16.7.
Time studies. A PNMI is
required to complete all time studies in accordance with the MaineCare Benefits
Manual, Chapter II, Section 97.07-8.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.