C.M.R. 10, 144, ch. 119, 1 - GENERAL DEFINITIONS

The following terms used in these regulations shall have the meanings specified.

1. Activities of Daily Living (ADL): means the functions or tasks for self-care which are performed either independently or with supervision or assistance. Activities of Daily Living include at least mobility, transferring, ambulating, grooming, bathing, dressing, eating and toileting.

2. Acute Care Services: are services provided to address severe, significant or serious illness.

3. Administrator: is a person having the authority and responsibility for the operation of the home health care agency and for staff performance in accordance with applicable requirements and policies of the agency. The administrator is a licensed physician, registered nurse, or an individual who has training and experience in health services administration, with at least one (1) year of supervisory or administrative experience in home health care services or related health programs.

4. Advanced Directive: means a document signed by the client, guardian or durable power of attorney, specifying the scope of treatments and/or procedures that are not to be carried out by others in the event that the client becomes unable to provide that direction. This document must be in compliance with the Federal 1990 Patient Self Determination Act (Omnibus Budget Reconciliation Act, Section 4206 ) and the Maine Uniform Rights of the Terminally Ill Act (Title 18-A Maine Revised Statutes Annotated § 5-801et seq.).

5. Agency Contracting or Arranging for Home Health Care Services: means an agency whose employees do not directly provide home health care services in the home. These agencies develop contractual agreements with licensed or legally exempted home health care agencies for the provision of home health care services. Agencies that contract or arrange for home health care services to be delivered, but whose employees do not directly provide home health cue services, shall be exempt from the provisions of these regulations.

6. Applicant: means the individual who signs the application for a home health care service license. The applicant must be the individual who has the ultimate responsibility for ensuring that a facility operates in compliance with these regulations.

7. Branch Office: means a location or site from which a home health care services agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the home health care services agency and is located sufficiently close to share administration, supervision, and services in a manner that renders it unnecessary for the branch independently to meet the State Home Health Care Services Licensing Regulations.

8. Bylaws: means a set of rules adopted by the home health care services agency for governing the agency's operation.

9. Certified Nursing Assistant (CNA): means a person whose duties are assigned by a registered professional nurse and who:

a. Has successfully completed a training program or course with a curriculum prescribed by the Maine State Board of Nursing, holds a certificate of training from that program or course and is listed on the Maine Registry of Certified Nursing Assistants, or

b. Was certified before September 29, 1987 and is listed on the Maine Registry of Certified Nursing Assistants.

10. Clinical Note: is a signed and dated clinical notation made at each patient visit by each health care staff person who renders a service to the patient. The clinical note shall be written or dictated on the day the service is rendered and shall be incorporated within a week into the patient's medical/health record according to the facility's policies and procedures The clinical note may include, but shall not be limited to:

a. A flow sheet, a written description of signs and symptoms, treatment and/or medication(s) administered, the patient's response and any changes in physical or mental status.

b. Progress note, a supplemental note concurrent with the plan of care whenever there is a change in the patient's condition or care which cannot dearly be documented on a flow sheet.

11. Commissioner. means the person who heads the Department of Health and Human Services.

12. Deeming: A Medicare certified home health agency is deemed to meet the State licensure requirements if it meets all Federal certification requirements.

13. Department: means the Maine Department of Health and Human Services.

14. Dietitian: is a person who is registered, or eligible for registration, by the Commission on Dietetic Registration of the American Dietetic Association and is licensed by the Maine State Board of Dietitians.

15. Director of Nurses: The Director of Nurses is a person having the authority and responsibility for the clinical services, in accordance with applicable requirements and policies of the agency. The Director of Nurses is a registered nurse currently licensed in the State of Maine, qualified by advanced education or management experience. The Director of Nurses must have one (1) year of clinical experience and at least two (2) years of supervisory or administrative experience in home health care services.

16. Documented: means written, signed and dated.

17. Full Time Equivalent Employee: is one or more individual(s) who is/are employed on the basis of at least 37 1/2 hours per week for the home health care service agency.

18. Governing Board: means the organization, person or persons designated to assume legal responsibility for the determination and implementation of policy and for the management, operation and financial viability of the facility.

19. Health Promotion: is any effort or combination of efforts designed to help bring about or further the development of the state of physical and mental well-being in individuals.

20. Home Health Aide: means a certified nursing assistant who meets both the requirements of this Chapter and the Code of Federal Regulations 42 CFR, Part 484.4.

21. Home Health Care Services Provider: is any business, entity or subdivision thereof, whether public or private, proprietary or not for profit, that is engaged in providing acute, restorative, rehabilitative, maintenance, preventive or health promotion services through professional nursing or another therapeutic service, such as physical therapy, home health aides, nurse assistants, medical social work, nutritionist services, or personal care services, either directly or through contractual agreement, in a patient's/client's place of residence. This term does not apply to any sole practitioner providing private duty nursing services or other restorative, rehabilitative, maintenance, preventative or health promotion services in a patient's/client's place of residence or to municipal entities providing health promotion services in a patient's/client's place of residence. This term does not apply to a federally qualified health center or a rural health clinic as defined in 42 United States Code, Section 1395x, subsection (aa) (1993) that is delivering case management services or health education in a patient's/client's place of residence. Beginning October 1, 1991, "home health care provider" includes any business entity or subdivision there of, whether public or private, proprietary or nonprofit, that is engaged in providing speech pathology services.

A Home Health Care Services Provider shall also be referred to as a home health care agency.

22. Home Health Care Services: are the in-home provision of professional nursing services, physical and/or occupational therapy, speech pathology, medical social work, nutritionist services and the supervised services of licensed practical nurses, home health aides and/or certified nurse assistants providing treatment and rehabilitation for illness or disability, aimed at restoring or maintaining independent functioning. These services are provided directly or through contractual agreement in the patient's/client's home and must be provided in the State of Maine. All licensed providers of home health care services must be located in the State of Maine, with a commercial address. The only exceptions are licensed home health care service providers located on the borders of Maine/New Hampshire and Maine/Canada.

23. Home Health Care Services Hotline: is a toll free number, established within the State of Maine, to receive complaints and/or questions about home health care services.

24. Home Health Paraprofessional Services: are health care services rendered by home health aides and certified nurse assistants involving selected technical nursing or personal care services delegated by registered professional nurses and supervised by them.

25. Instrumental Activities of Daily Living (IADL): means the functions or tasks for self-care which are performed either independently or with supervision or assistance. IADLs include preparing light and full meals, light housekeeping, personal laundry, handling money and using a telephone.

26. Job Description: means written specifications developed for each personnel position in the facility, containing the qualifications, duties, competencies, responsibilities, and accountability required of employees.

27. Licensed Health Care Professionals: are health care providers including physicians, registered professional nurses, licensed practical nurses, occupational therapists, speech pathologists, physical therapists, dietitians and social workers that have been authorized to practice a health care profession in accordance with state law.

28. Licensed Practical Nurse: is an individual who possesses a current license and is authorized to perform tasks and responsibilities for compensation under the direction of a registered professional nurse, physician, or dentist, as authorized in Title 32 MRSA, Section2101, et seq.

29. Maintenance Services: are activities designed to keep the patients/clients at their present level of functioning.

30. Multidisciplinary Team: is a group of health care professionals and paraprofessionals that may include, but are not limited to the following: physicians, registered professional nurses, care managers, physical and occupational therapists, dietitians, speech pathologists, medical social workers, licensed practical nurses, certified nursing assistants, and home health aides. These health care individuals work together in an attempt to meet the total health care needs of the patient/client in the home.

31. Occupational Therapist: is an individual who is currently registered with the American Occupational Therapist Association and possesses a current license authorized by Title 32 MRSA §2271et seq.

32. Patient/Client: is a person who receives home health care services.

33. Personal Care Services: are those services provided in a patient's/client's residence by a home health aide or certified nursing assistant and which are delegated and supervised by a registered nurse (services provided by a personal care assistant (PCA), as defined in the Rules for the Home Based Care Program are not included in this definition).

34. Physical Therapist: is an individual who possesses a current license authorized by Title 32 MRSA §3111et seq.

35. Plan of Care: is a systematic, individualized written plan developed by a home health cue services agency's professional staff in conjunction with the patient/client, family and/or significant others. This plan of care must be updated as the patient's needs change. These changes include at least those activities which shall be provided to the patient by the agency to meet their needs.

36. Policies: are written standards which govern the provisions of home health care services.

37. Preventive Services: are services provided in the home by health care professionals or paraprofessionals designed to promote the health of individuals so that illnesses will not occur.

38. Procedures: are specific, written directions to accomplish policies.

39. Progress Note: means a written notation, dated and signed by a member of the multidisciplinary team, that summarizes facts about care furnished and the patient's response during a given period of time.

40. Proprietary Agency: means a private profit making agency licensed by the state.

41. Protocols: are written guidelines that define the limits and extent of practice for health care in a home health care services agency.

42. Registered Professional Nurse: is an individual who possesses a current license authorized by the Maim State Board of Nursing pursuant to Tide 32 MRSA §2102(5), and 32 M RSA §§ 2101et seq.

43. Rehabilitative Services: are services provided by home health care providers which are designed to assist patients/clients regain their former functional abilities.

44. Restorative Services: are services which provide treatment or therapy to improve patient/client health and functioning in order that he/she may achieve or maintain an optimum level of self care and independence.

45. Signature: means at least the first initial and full surname and title (for example, S. Jones, R.N.) of a person, legibly written, generated by computer with authorization safeguards, or communicated by a facsimile communications system (FAX).

46. Social Worker: is an individual who possesses a current license authorized by Title 32 MRSA § 705et seq. If the individual is not a Master's level licensed Social Worker, he/she must be supervised in accordance with the requirements of the Board of Social Work.

47. Speech Pathologist: is an individual who is currently licensed by the State of Maine Speech Pathology and Audiology Licensing Board to act as a speech pathologist pursuant to Tide 32 MRSA § 6020et seq.

48. Staff Education Plan: means a written plan, developed at least annually by agency professional staff and implemented throughout the year, which describes a coordinated program for staff education, including inservice programs and on the job training.

49. Staff Orientation Plan: means a written plan for the orientation of each new employee to the duties and responsibilities of the services to which he/she has been assigned, as well as to the personnel policies of the facility.

50. Sub Unit: means a semi-autonomous organization that:

a. Serves patients in a geographic area different from that of the parent agency; and

b. Must independently meet the Home Health Care Services Regulations because, geographically, the parent agency is unable to share administration, supervision and services on a daily basis.

51. Supervision: means authoritative procedural guidance by a qualified person for the accomplishment of a function or activity within his/her sphere of competence, with initial direction and periodic on-site inspection of the actual act of accomplishing the function or activity.

52. Therapeutic Service: is a healing act based upon a knowledge of disease and of the remedies employed. Therapeutic services are provided by health care professionals and paraprofessionals in accordance with the plan of care developed by a licensed health care professional.

Notes

C.M.R. 10, 144, ch. 119, 1