Subsection 144-101-II-103.06 - POLICIES AND PROCEDURES103.06-1Professional Staff In order for a clinic to receive reimbursement, its professional staff must be conditionally, temporarily or fully licensed, or otherwise recognized or approved to practice, in the state where services are provided as documented by written evidence from the appropriate governing body, including: physicians, podiatrists, physician assistants, advanced practice registered nurse practitioners, nurse-midwives, clinical nurse specialists, clinical psychologists, clinical social workers, clinical professional counselors, registered nurses, licensed practical nurses, respiratory therapists, dentists and dental hygienists. MaineCare will also reimburse for advanced practice or registered nurses who hold a current, unencumbered compact license from another compact state that they claim as their legal residence. Qualifications of any other staff must be provided and billed in accordance with all other applicable sections of the MaineCare Benefits Manual.
103.06-2Supervision By a Physician The responsible supervising physician, or other suitably licensed practitioner, to the extent required by applicable state laws or regulations, whose presence at the clinic is not required at all times, must:
1. always be available through telecommunication for consultation, assistance or referral;2. supervise the services of the clinic's medical staff providing services under the responsible physician supervisory agreement;3. supervise nurses and other auxiliary medical staff providing services or supplies; and4. review, approve, cosign and date the medical records of members seen by the clinic's medical staff practicing under the physician's supervision.103.06-3Member Records There shall be a specific record for each member which shall include, but not necessarily be limited to:
A. the member's name, address, and birth date;B. the member's social and medical history, as appropriate;C. a description of the findings from the physical examination;D. long and short range goals, as appropriate;E. a description of any tests ordered and performed and their results;F. a description of treatment or follow-up care and dates scheduled for revisits;G. any medications and/or supplies dispensed or prescribed;H. any recommendations for and referral to other sources of care;I. the dates on which all services were provided; andJ. written progress notes, which shall identify the services provided and progress toward achievement of goals.K. For members receiving mental health services, the following additional record-keeping requirements apply: 1.Initial Assessment/Clinical Evaluation. An initial assessment, which must include a direct encounter with the member, and his/herfamily if appropriate, shall be performed and included in the member's RHC record. The assessment must include the member's medical and social history and must include the member's diagnosis and the professional who made the diagnosis and that person's credentials.2.Individual Treatment/Service Plan. An individual treatment/service plan must be developed by the third mental health visit. This individual treatment/service plan shall be in writing and shall identify mental health treatment needs, and shall delineate all specific services to be provided, the frequency and duration of each service, the mental health personnel who will provide the service, and the goals and/or expected outcomes of each service. Treatment plans must be reviewed and approved by a psychiatrist, physician, psychologist, or licensed clinical social worker, licensed clinical professional counselor or advanced practice psychiatric and mental health nurse, or a registered nurse certified in the specialized field of mental health within thirty (30) days of entry of the member into mental health treatment.3. Written treatment or progress notes shall be maintained in chronological order, and shall be made for each mental health visit. These notes shall identify who provided the service, the provider's credentials, on what date the service was provided, its duration, and the progress the member is making toward attaining the goals or outcomes identified in the treatment plan.4. 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.).5. In cases where RHC mental health services are needed in excess of two hours per week to prevent hospitalization, documentation must be included in the file and signed by a psychiatrist, physician, psychologist, licensed clinical social worker, licensed clinical professional counselor, clinical nurse specialist, or a registered nurse certified in the specialized field of mental health.6.Discharge/Closing Summary. A closing summary shall be signed and dated and included in the clinical record of discharge treatment and outcome in relation to the individual treatment/service plan 7. In the event a member receives group services, there shall be no names of other group participants in the member's record. Entries are required for each service billed and must include the name, credentials, and signature of the service provider. See Chapter I of the MaineCare Benefits Manual for additional record keeping requirements.
Physician supervision must be performed in accordance with the Maine Board of Licensure in Medicine or the Maine Board of Licensure in Osteopathy requirements.
103.06-4Program IntegritySee Chapter I of the MaineCare Benefits Manual.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-103, subsec. 144-101-II-103.06