Subsection 144-101-II-2.04 - COVERED SERVICES2.04-1A. Personal Care ServicesServices: Services covered under adult family care services include the following Personal Care Services:
1. Assistance with activities of daily living such as bathing, dressing, eating, toileting, ambulation, transfers, changing positions in bed, personal hygiene, and grooming (shaving, oral care, shampooing, and nail care), bladder and bowel requirements, routine catheter care and routine colostomy care;2. The performance of instrumental activities of daily living and incidental household tasks essential to the activities of daily living or to the maintenance of the member's health and safety within the facility, such as meal preparation, and bed making, dusting and vacuuming of the member's room;3. Supervision of, or assistance with, administration of prescribed medication;4. Personal supervision or awareness of the member's general safety and whereabouts; observation or monitoring of the member to ensure and promote his/her health and safety; reminding the member to carry out activities of daily living or of important appointments; and assisting the member in adjusting to residence in the facility;5. Arranging transportation and making phone calls for appointments as recommended by medical providers, as well as reporting deviations or changes from the member's normal appearance, behavior or state of health to the guardian, physician, or designated health services provider; and 6. Arranging or providing motivational and diversionary activities (individual or group) that focus on social interaction to reduce isolation or withdrawal and to enhance communication and social skills.B.Professional RN Services1. A professional nurse (RN) must monitor the status and needs of each member when medically necessary in the RN's professional judgment and at least every 90 days. The RN shall review the MDS-ALS, progress notes, and medications, discuss the status of the member with the provider, see the member face-to-face if medically necessary, and initial and date the member's individual service plan at least every 90 days. This information must be maintained in the member's record (See Section 2.07-2), together with recommendations of the RN concerning the health care of the member.2. Professional Private Duty Nursing Services, as set forth in Section 96 of this Manual, may be provided to a member directly by an AFC services provider who is an RN and who is enrolled as a MaineCare provider. The member's nursing services must be authorized and signed by the member's physician every 60 days and maintained in the member's medical record in the facility. Services shall be delivered and billed in accordance with the requirements of Chapter II, Section 96.2.04-2Service settingIn order to qualify for reimbursement under this Section, AFC services must be delivered in either a Level III Residential Care Facility or Assisted Housing Program: Level IV Residential Care Facility.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-2, subsec. 144-101-II-2.04