The provider must document each service provided, the date of each service, the type of service, need or goal to which the service relates, the length of time of the service, and the signature of the individual performing the service.
To provide services under this section a provider must be a qualified vendor as approved by DHHS 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 DHHS.
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 plan, intervention must be consistent with the DHHS's rule governing emergency intervention and behavioral treatment for persons with intellectual disabilities (14-197 CMR Chapter 5). It may also be necessary to seek emergency medical or safety assistance when needed and comply with Reportable Events reporting requirements.
All staff, regardless of length of employment, must have Behavioral Regulations (14-197 CMR, Chapter 5), Regulations Regarding Reportable Events, Adult Protective Investigations and Substantiation Hearings Regarding Persons with Mental Retardation and Autism (14-197, ch 12), and Rights of Persons with Intellectual Disabilities or Autism Training (Title 34-B §5605). These trainings are required every thirty-six (36) months. Documentation of training must be maintained in provider personnel files,
Additional information regarding provider requirements can be found in APPENDIX IV- Additional Requirements for Section 29 Providers Community Support Services and Employment Specialist Services.
29.10-1Direct Support Professional (DSP) The following requirements apply to DSPs:
A. DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or DHHS's approved Assessment of Prior Learning, or successfully complete the Maine College of Direct Support within six (6) months of date of hire.B. Prior to providing services to a member alone, a DS 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 Choice4. Maltreatment Documentation of completion must be retained in the personnel record.
C. 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. Regulations Regarding Reportable Events, Adult Protective Investigations and Substantiation Hearings (14-197, Ch. 12)2. Regulations Governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism in Maine (14-197, Ch. 5)3. Rights and Basic Protections of a Person with an Intellectual Disability or Autism (Title 34-B §5605)4. Grievance Training (14-197, ch. 8). This training must be completed before working with members.D. DSPs must have a background check completed consistent with Section 29.10-4.E. DSPs must have an adult protective and child protective record check.F. DSPs must be at least eighteen (18) years of age.G. DSPs must have graduated from high school or acquired a GED.H. DSPs must have current CPR and First Aid Certification.I. 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 Shared Living model homes and authorized, certified, or approved by DHHS.J. 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.K. A DSP who also provides Career Planning must have completed the additional employment modules in the Maine College of Direct Support and an additional twelve (12) hours of Career Planning and Discovery training provided through Maine's Workforce Development System.L. All new staff or subcontractors must complete the Maine College of Direct Support within six (6) months of actual employment from 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.M. A person who provides Direct Support must be a DSP regardless of his or her status as an employee or subcontractor of an agency. A DSP can supervise another DSP.N. Only a DSP who is certified as a Certified Nursing Assistant-Medications (CNA-M), a Certified Residential Medication Aide (CRMA), or a Registered Nurse (RN) may administer medications to a member.O. A DSP may supervise another DSP.29.10-2Employment Specialist is a person who provides Employment Specialist Services or Work Support. The following requirements apply to Employment Specialists: A. Employment Specialists must Successfully complete the Maine Employment Curriculum for Employment Specialist Certification as approved by DHHS. (approved courses are listed at: http://www.employmentforme.org/providers/crp-training.html) Certification must occur within six (6) months of hire.B. Employment specialists must be supervised during the first six months of hire by a Certified Employment Specialist in order to provide services.C. Employment Specialists must have graduated from high school or acquired a GED.D. Staff can either be certified as an Employment Specialist or complete the Approved Direct Support Curriculum along with additional modules specific to employment.E. Employment Specialists must have satisfied a background check consistent with Section 29.10-4.F. Employment Specialists must have 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 (six) hours of Department approved continued education every twelve (12) months.29.10-3Emergency Intervention- All providers must follow DHHS's rule governing emergency intervention and behavioral treatment for persons with Intellectual Disabilities (14-197 CMR Chapter 5), and must meet training requirements on approved behavioral interventions procedures (e.g., Mandt) if applicable and indicated as a need in the member's Personal Plan.29.10-4Shared Living (Foster Care, Adult)The Shared Living Home Provider maintains a supportive home environment that promotes community inclusion with an appropriate level of support and supervision.
The Shared Living Home Provider is required to:
A. Maintain a clean and healthy living environment addressing any necessary member-specific environmental or safety standards (see Appendix IV).B. Attend to the member's physical health and emotional well-being.C. Participate as a part of the member's Person-Centered Planning Team and maintain open communication with the Case Manager, Administrative Oversight Agency, guardian and Person-Centered Planning Team. D. Assist in transition, admission, or discharge plans. E. Include the member in family and community life, assisting the member to develop healthy relationships and increased community independence.F. Provide community access to services and activities desired by the member but not limited to; religious affiliation (if desired), physical activities, shopping, volunteering, etc.G. Maintain professional daily documentation in accordance with MaineCare requirements.H. Maintain daily documentation of all medication administered to the member or by self-administration.I. Report any unusual incidents to the member's team (Case Manager, Administrative Oversight Agency and guardian) and, when required, through the Reportable Events Reporting System.J. Report to the member's team all changes in household members or legal status of household members.K. Maintain current homeowner's or renter's insurance at all times.L. Provide the transportation to appointments and activities.M. Maintain a valid Maine driver's license and a properly registered, inspected, insured and maintained vehicle.N. Enter into a contract for professional support with the Administrative Oversight Agency.29.10-5Background Check Criteria -The provider must conduct background checks every two years on all employees, persons contracted or hired, consultants, volunteers, students, and other persons who may provide 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. Background checks are required for any adult residing in a Shared Living Home. Background checks must be completed before a hire is finalized and prior to the employee working with members. 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; orB. 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; orD. 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. any criminal conviction within Title 29-A, chapter 23, subchapter 2, article 1, or Title 29-A, chapter 23, subchapter 5. Employment of individuals with records of such convictions more than five (5) years ago is a matter within the provider's discretion after consideration of the individual's criminal record in relation to the nature of the position. 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 an 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. Within 60 days of the effective date of this rule, 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 responsibility of the provider.
29.10-6Informed Consent PolicyProviders must put in place and implement an informed consent policy approved by the 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.
29.10-7Reportable Events& Behavioral TreatmentProviders shall comply with all terms and conditions of the Department's Regulations Governing Reportable Events, Adult Protective Investigations and Substantiation Hearings regarding persons with Intellectual Disabilities or Autism as described in 14-197 CMR, chapter 12. All staff must receive training in mandatory reporting/reportable events and Behavioral Regulations either before they begin work with members or, at the latest, six (6) months of being hired and every thirty six (36) months thereafter. All staff must receive the following Department sponsored training;
A. Regulations Regarding Reportable Events, Adult Protective Investigations and Substantiation Hearings Regarding Persons with Mental Retardation and Autism. (14-197, Ch. 12)B. Regulations Governing Behavioral Support, Modification, and Management for People with Intellectual Disabilities or Autism in Maine (14-197, Ch. 5); andC. Rights and Basic Protections of a Person with an Intellectual Disability or Autism (Title 34-B §5605) Completion of trainings should occur before staff begin work with members or within six (6) months of the date of hire and every thirty six (36) months thereafter. All staff, regardless of length of employment, must have documentation of training completion in their personnel file.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-29, subsec. 144-101-II-29.10