To provide services under this section a provider must be a Qualified Vendor as approved by OADS and enrolled by the MaineCare program. Once a provider has been authorized to provide services, the provider cannot terminate the Member's services without written authorization from OADS. providers must ensure staff are trained in identifying risks, such as risk of abuse, neglect, or exploitation; participating in a Member's risk assessment; identifying and reporting to an immediate supervisor changes in health status and behavior; anticipating or preventing unsafe or destructive behavior; and safely intervening against undesirable behavior according to an intervention plan. Any intervention must be consistent with the DHHS's rule governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism (14-197 C.M.R. ch 5). It may also be necessary to seek emergency medical or safety assistance when needed and comply with reporting requirements outlined in DHHS's Reportable Events System (14-197 C.M.R. ch 12) and/or Adult Protective Services System (10-149 C.M.R. ch 1).
21.10-1Direct Support Professional (DSP) The following requirements apply to DSPs:
A. DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or demonstrated proficiency through DHHS's approved Assessment of Prior Learning, or has successfully completed the Maine College of Direct Support within six (6) months of date of hire.a. Prior to providing services to a Member alone, a DSP must complete the following four modules from the College of Direct Support, including computer based and live sessions: 1. Introduction to Developmental Disabilities3. Individual Rights and Choiceb. Documentation of completion must be retained in the personnel record.B. DSPs must complete the following Department-approved trainings, within the first six (6) months from date of hire and thereafter every thirty-six (36) months; 1. Reportable Events System (14-197 C.M.R. ch 12) and Adult Protective Services System (14-197 C.M.R. ch. 12)2. Regulations Governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism in Maine (14-197 C.M.R. ch. 5)3. Rights and Basic Protections of a Person with an Intellectual Disability or Autism ( 34-B M.R.S. §5605) .4. DSPs, regardless of capacity and prior to provision of service to a Member, must be trained upon hire and annually thereafter on the Global HCBS Waiver Person Centered Planning and Settings Rule, Maine Care Benefits Manual, Chapter 1, Section 6;C. DSPs must have a background check consistent with Section 21.10-10;D. DSPs must have an adult protective and child protective record check;E. DSPs must be at least eighteen (18) years of age;F. DSPs must have graduated from high school or acquired a GED;G. DSPs must have current CPR and First Aid Certification;H. A DSP is legally authorized to assist with the administration of medication if the DSP is certified as a Certified Nursing Assistant-Medications (CNA-M); as a Certified Residential Medication Aide (CRMA), or a Registered Nurse (RN), or otherwise has been trained to administer medications through a training program specifically for Family-Centered or Shared Living model homes and authorized, certified, or approved by DHHS;I. A DSP who also provides Work Support- Individual or Work Support-Group must have completed the additional employment modules in the Maine College of Direct Support in order to provide services;J. A DSP who also provides Career Planning must successfully complete Maine's "Direct Support Professional Curriculum," or the "Maine College of Direct Support" program and additional employment modules, or the College of Employment Services Certificate, as follows:a. Employment Specialist National (ACRE approved) Certification may be substituted for CDS and employment modules as it is a higher level of staff certification;b. Additional 12 hours of Career Planning and Discovery provided through Maine's Workforce Development System (www.employmentformewds.org) for either the Direct Support Professional or the Employment Specialist;c. An additional 6 hours annually of DHHS approved continuing education;K. A DSP who provides Employment Specialist Services must hold a Certificate of completion of State of Maine Employment Curriculum for Employment Support Personnel and successfully complete Maine's "Direct Support Professional Curriculum" or the "Maine College of Direct Support" program and additional employment modules; a. Employment Specialist National (ACRE approved) Certification may be substituted for CDS and employment modules as it is a higher level of staff certification;L. A DSP who provides Crisis Intervention Services must have behavioral intervention training on approved behavioral interventions procedures (e.g., MANDT);M. All new staff or subcontractors must complete the Maine College of Direct Support within six (6) months of actual employment, calculated from their date of hire. Evidence of date of hire and enrollment in the training must be documented in writing in the employee's personnel file or a file for the subcontractor. Services provided during this time are reimbursable as long as the documentation exists in the personnel file;N. A person who provides Direct Support must be a DSP regardless of his or her status as an employee or subcontractor of an agency; andO. A DSP can supervise another DSP.21.10-2Assistive Technology Assessment: In order to provide an Assistive Technology Assessment, an enrolled provider must possess the following qualifications (Either A or B). A.License Requirements1. Occupational Therapist or;B.Certificate RequirementsA Direct Support Professional (DSP) must be certified as a:
1. Rehabilitation Engineering Technologist (RET) or;2. Assistive Technology Professional (ATP) from the Rehabilitation Engineering and Assistive Technology Society of North American (RESNA).21.10-3A Crisis Assessment Team is a team of clinicians convened to provide Crisis Assessment Services. The team may include, but is not limited to, any or all of the following, if licensed or certified to practice within their profession: A. Neuropsychiatrist or psychiatrist, who has worked with persons with developmental disabilities as a primary part of their practice;B. Psychologist or behaviorist who has worked with persons with developmental disabilities as a primary part of their practice;C. Clinic liaison person, having a bachelor's degree or a nursing degree; direct experience with persons with developmental disabilities; and extensive experiences that provide a working knowledge of medical, psychiatric, and behavioral perspectives;D. General medical practitioner;E. Occupational therapist;F. Physical therapist; or21.10-4An Employment Specialist is a person who provides Employment Services or Work Support and has:B. Supervision during the first six months of hire from a Certified Employment Specialist;C. Received certification as an Employment Specialist or completed the approved Direct Support Curriculum along with additional modules specific to employment;D. Graduated from high school or acquired a GED;E. Had a background check consistent with Section 21.10-10; andF. Worked for a minimum of one (1) year with a person or persons having an Intellectual Disability or Autism Spectrum Disorder in a work setting.G. An Employment Specialist who also provides Career Planning must have completed the additional twelve (12) hours of Career Planning and Discovery provided through Maine's Workforce Development System and six (6) hours of Department approved continued education every twelve (12) months.21.10-5Phase-Out of Family-Centered SupportDHHS is discontinuing the Family-Centered Support service. If a bed becomes vacant in a Family-Centered Support home, that vacancy may be filled.
Existing Family-Centered Support providers must meet all the requirements of a Direct Support Professional as set forth in these rules.
Effective with this rule, no new licenses or license transfers for Family-Centered Support homes will be approved.
Providers of Family-Centered Support shall not transfer, in whole or in part, ownership, management, or responsibility for day-to-day operations of the Family-Centered Support home to another individual or entity. DHHS will not authorize Family-Centered Support services under a new license.
21.10-6Residential Vacancies in Two-Person HomesA. On the next business day, from the time of vacancy, the provider shall provide notice of the vacancy to the responsible OADS Resource Coordinator and the Case Managers for both the departing and remaining Members.B. No later than three (3) business days from the time of vacancy, the provider shall submit a new proposed staffing pattern for the home that adjusts for the vacancy and is sufficient to maintain the remaining Member's safety.C. If the vacancy is the result of hospitalization, the provider may hold the vacant bed for the hospitalized Member for a period of thirty (30) calendar days. If, after thirty calendar days, there is no imminent plan for the hospitalized Member to return to his or her home, the provider shall issue a thirty-day (30) discharge notice to the hospitalized Member, his or her guardian, and DHHS and proceed with the steps below.
D. If the provider determines that the remaining Member cannot be safely served in the current residence with a new housemate, the provider shall issue a thirty-day discharge notice to the remaining Member and DHHS within five (5) business days of the vacancy (or, where the vacancy results from hospitalization, from the passage of thirty days from the time of hospitalization).E. If the provider determines that the remaining Member can be safely served in the current residence with a new housemate, the provider and DHHS shall attempt to identify another Member to fill the vacancy.1.Ninety-Day Letter: If no suitable candidate to fill the vacancy has been found after ninety calendar days from the date of vacancy (or, where the vacancy results from hospitalization, from the passage of thirty days from the time of hospitalization), the provider shall send a letter to the remaining Member and his or her guardian, where applicable, stating that no suitable housemate has been located and that the Member should consider looking for other residential options within or outside the provider agency. The letter shall state clearly that, should the provider be unable to fill the vacancy within thirty (30) days of the letter, the provider will issue a thirty-day discharge notice.2.Thirty-Day Discharge Notice: If no suitable candidate to fill the vacancy has been found after thirty (30) calendar days from the mailing of the ninety-day (90) letter, the provider shall issue a thirty-day (30) discharge notice to the Member, his or her guardian, where applicable, and DHHS. The provider shall cooperate with the Member's planning team in developing a transition plan for the Member to move to other housing, whether permanent or interim, within thirty (30) days. Should the provider fail to meet the obligations set forth above, DHHS may suspend reimbursement to the provider for the remaining Member's Home Support.
21.10-7Shared Living (Foster Care, Adult) The Shared Living Provider must be a Certified Direct Support Professional (DSP) who has met all the requirements to provide this service. The Shared Living Provider must enter into a contractual relationship with the Administrative Oversight Agency in order to provide services to a Member. The agency supports the provider in fulfilling the requirements and obligations agreed upon by the DHHS, the Administrative Oversight Agency, and the Member's Planning Team as documented in the Member's Person-Centered Service Plan.
21.10-8Additional Requirement of MaineCare Provider ParticipationAll Section 21 Providers must comply with all applicable federal and state law, including applicable Maine licensing laws and regulations. Chapter I, Section 1 of the MaineCare Benefits Manual requires that MaineCare providers must maintain current licenses, as applicable, and must submit copies of license renewals to the OMS Provider Enrollment Unit.
21.10-9Electronic Visit Verification (EVV) Every provider of Home Support-Quarter Hour services must comply with Maine DHHS Electronic Visit Verification ("EVV") system standards and requirements. In compliance with Section 12006 of the 21st Century CURES Act ( P.L. 114-255), as codified in 42 U.S.C. § 1396b(l)(1), visits conducted as part of such services must be electronically verified with respect to: the type of service performed; the individual receiving the service; the date of the service; the location of the service delivery; the individual providing the service; and the time the service begins and ends. Providers may utilize the Maine DHHS EVV system at no cost, or may procure and utilize their own EVV system, so long as data from their own or a third party EVV system can be accepted and integrated with the Maine DHHS EVV system.
21.10-10Background Check Criteria The provider must conduct background checks every two (2) years on all prospective employees, persons contracted or hired, consultants, volunteers, students, and other persons who maybe providing Direct Support Services under this Section. A background check is required for any adult who may be providing direct or indirect services where the Member receives Shared Living or Family-Centered Support. Background checks are required for any adult residing in a Family-Centered or Shared Living Home. Background checks on persons professionally licensed by the State of Maine will include a confirmation that the licensee is in good standing with the appropriate licensing board or entity. The provider shall not hire or retain in any capacity any person who may directly provide services to a Member under this Section if that person has a record of:
A. any criminal conviction that involves abuse, neglect or exploitation;B. any criminal conviction in connection to intentional or knowing conduct that caused, threatened, solicited or created the substantial risk of bodily injury to another person;C. any criminal conviction resulting from a sexual act, contact, touching or solicitation in connection to any victim;D. any other criminal conviction, classified as Class A, B or C or the equivalent of any of these, or any reckless conduct that caused, threatened, solicited or created the substantial risk of bodily injury to another person within the preceding two (2) years; orE. a habitual offender status under 29-A M.R.S. §2551-A. The provider shall contact child and adult protective services (including OADS and the Office of Child and Family Services) units within State government to obtain any record of substantiated allegations of abuse, neglect or exploitation against an employment applicant before hiring the same. In the case of a child or adult protective services investigation substantiating abuse, neglect or exploitation by a prospective employee of the provider, it is the provider's responsibility to decide what hiring action to take in response to that substantiation, while acting in accordance with licensing standards. All staff and all adults residing with a Member must have all background checks completed. All background checks must be completed every twenty-four (24) months thereafter. Costs for background checks are the provider's responsibility.
21.10-11Emergency Intervention and Behavioral Treatment A provider must follow DHHS's rule governing emergency intervention and behavioral treatment for persons with Intellectual Disabilities (14-197 C.M.R. ch. 5), and training on approved behavioral interventions procedures (e.g., Mandt) if applicable and indicated as a need in the Member's PCSP.
21.10-12Informed Consent Policy Providers must put in place and implement an informed consent policy approved by DHHS. For the purposes of this requirement, informed consent means consent obtained in writing from a person or the person's legally authorized representative for a specific treatment, intervention or service, following disclosure of information adequate to assist the person in making the consent. Such information may include the diagnosis, the nature and purpose of the procedure(s) or service(s) for which consent is sought, all material risks and consequences of the procedure(s) or service(s), an assessment of the likelihood that the procedure(s) or service(s) will accomplish the desired objective(s), any reasonably feasible alternatives for treatment, with the same supporting information as is required regarding the proposed procedure(s) or service(s), and the prognosis if no treatment is provided. At a minimum, a provider's informed consent policy must ensure that Members served by the provider (and their guardians, where applicable) are informed of the risks and benefits of services and the right to refuse or change services or providers.
21.10-13Rights, Reportable Events, and Behavioral Support Training Providers shall comply with all terms and conditions as described in:
a. Reportable Events System (14-197 C.M.R. ch. 12); andb. Adult Protective Services System (10-149 C.M.R. ch. 1); andc. Regulations Governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism in Maine (14-197 C.M.R. ch. 5); andd. Rights and Basic Protections of a Person with an Intellectual Disability or Autism ( 34-B M.R.S. §5605) . As such, providers will ensure that staff members receive Department-sponsored training regarding all the regulations listed above (items a. through d.). Ideally, newly hired staff will receive training in advance of working with any Member or, at the latest, within six (6) months of being hired and every thirty-six (36) months thereafter. Providers will maintain documentation of all training within individual personnel files, regardless of the staff member's length of employment.
21.10-14Plan of Corrective Action (POCA)A. Notice of Deficiency: The Department may issue a written notice of deficiency to a provider. The Notice of Deficiency will describe each deficiency with specificity, and will identify any regulation (including Ch. II, Sec. 21 Appendix V), policy, or statutory requirement with which the Department alleges the provider is not in compliance. The Notice of Deficiency may state that the provider is required to submit a Plan of Corrective Action to the Department, as described below. B. Plan of Corrective Action (POCA): Within 30 days after receiving notification of any deficiency, including a deficiency with respect to the requirements of Appendix V, a provider must submit a Plan of Corrective Action (POCA) for approval by the Department. The Department will approve, reject, or suggest changes to, the POCA, in writing. If the Department rejects a POCA, the written notice of rejection will explain the reason(s) why the POCA is being rejected, and may suggest changes to the POCA.C. The POCA must meet the following requirements: (1) The POCA must be a specific plan which describes how the deficient circumstance(s) (event, incident, or risk) will be corrected, including the actions which will be taken to bring about correction. (2) The POCA must address correction of the specific deficient circumstance(s) cited. In those instances where the deficiency resulted from a previously missed time frame, the plan must include an immediate correction of the deficient circumstance(s) even though the required time frame has been missed.(3) The POCA must address all identified areas where the correction of all related deficient circumstances would be implemented as specific deficiencies cited may not represent all instances within the site/service where the practice is deficient. It is, therefore, the provider's responsibility to identify and correct the deficiency throughout the site/service.(4) The POCA must identify actions steps to prevent the deficient circumstance(s) from recurring/occurring. When monitoring systems are to be implemented, the plan will include the type of monitoring, detail for implementation, as well as the responsible party/entity.(5) The POCA must clearly delineate the frequency each element of the plan is to occur. Such terms as "frequently," "periodically," "as needed" and "ongoing" lack the necessary specificity to be acceptable.(6) The POCA must identify by title the individual(s) responsible for the implementation and monitoring of the plan. The individuals identified must be employed by the provider.(7) The POCA must provide date(s), to run from the date of Department approval of the POCA, by which all components of the plan will be implemented, and the corrections completed. The length of time to correct the deficiency specified by the POCA must be as soon as possible. (8) The POCA should not duplicate or closely parallel a previously submitted failed plan.D. Notice of Corrections: When the provider has successfully completed and complied with the POCA, the agency will issue written notice to the Department. The Notice of Correction document will address each deficiency that was listed in the Notice of Deficiency, and explain, in writing, how the provider complied with the POCA to resolve each deficiency. Provider Appeals: Providers can appeal a Notice of Deficiency within 60 days of receipt of the Notice.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-21, subsec. 144-101-II-21.10