Subsection 144-101-II-109.09 - POLICIES AND PROCEDURES109.09-1RecordsThe provider will maintain an individual record for each member eligible for MaineCare reimbursement, including but not limited to:
A. Name, birthdate, MaineCare ID Number.B. Referral from a practitioner of the healing arts as allowed by the respective licensing authority and his or her scope of practice, made in writing or by telephone prior to the delivery of service. Written referral confirming a telephone referral must be included in the record within thirty (30) days of the original order.C. Pertinent medical information, as available, regarding the member's condition.D. Appropriate hearing and/or speech-language evaluation and diagnosis.E. A plan of care which includes identified problems, treatment in relation to the problems, and obtainable goals. This plan shall be updated in relation to the member's progress in reaching the goals.F. Documentation of each visit, showing the date of service, the service performed, the start time and stop time of the service, indicating the total time spent in delivering the service, and the signature of the individual performing the service.G. Progress notes written regularly (at least quarterly), which state the progress which the member has made in relation to the plan of care.H. A discharge summary with a copy sent to the referring practitioner of the healing arts.I. Copies of prior authorization or any other pertinent information concerning the member. Members' records will be kept current and available to the Department as documentation of services included on invoices.
109.09-2Audiology Reports and Plan of CareThe report of hearing evaluation or specific audiology procedures will include a plan of care based on audiologic and other data obtained. The plan of care is a prerequisite to aural rehabilitation and speech-language therapy, and should include but not be limited to: Diagnosis with severity rating, short and long-term goals(s) and objectives, method of evaluating member change, estimated time to achieve goal(s) and objectives, frequency and duration of therapy contacts, and periodicity of review.
109.09-3Qualified Professional StaffA. A speech-language pathologist must hold a valid license from the State or Province in which the services are provided in order to receive reimbursement.B. Audiologists must hold a valid license for the State or Province in which the services are provided in order to receive reimbursement.C. A speech-language pathology assistant must be registered as a speech-language pathology assistant by the Maine Board of Examiners on Speech-Language Pathology and Audiology, as documented by written evidence from such Board, or be registered in accordance with the licensure of the State or Province in which services are provided. A speech-language pathology assistant must be supervised by a licensed speech-language pathologist.
D. A speech and language clinician must be a licensed speech-language pathologist.109.09-4Division of Program IntegrityMembers under the age of twenty-one (21) may get the speech and hearing services for which they qualify, and which are covered in the MaineCare Benefits Manual. However, the Department or its authorized agent will review speech and hearing services for children under the age of twenty-one (21) for medical necessity as outlined in Chapter I of this Manual.
See Chapter I of this Manual for additional information on Division of Program Integrity activities.
109.09-5Procedure to Request Prior AuthorizationTo request prior authorization of adult services, the request must be made in writing to:
Prior Authorization Unit
Division of Health Care Management
Office of MaineCare Services
11 State House Station
Augusta, Maine 04333-0011
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-109, subsec. 144-101-II-109.09