C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-3, subsec. 144-101-II-3.06

Current through 2024-51, December 18, 2024

Subsection 144-101-II-3.06 - POLICIES AND PROCEDURES

3.06-1Professional Staff

A.Physician

A physician is a doctor of medicine or osteopathy who possesses a current license to practice medicine and/or osteopathy in the State in which services are to be provided.

B.Nurse Practitioner

A nurse practitioner is a graduate of a nurse practitioner program approved by the appropriate national accrediting body for that specific area of practice and who is currently licensed to practice as a registered professional nurse in the State in which services are to be provided and who is legally authorized under State law and regulations to practice as a nurse practitioner.

C.Physician Assistant

A physician assistant is a person who has completed an appropriate training program that has been approved by the Board of Registration in Medicine or Osteopathy and passed any competency examination required by this board. Before being permitted to practice, such person must obtain a certificate of qualification from the Board of Registration in Medicine and, at least bi-annually, a certificate of registration from the State in which the services are to be performed. Such services may be performed only when delegated by a physician and when done under written protocols.

D.Licensed Clinical Social Worker (LCSW)

A social worker must hold a Master's Degree from a school of social work accredited by the Counsel on Social Work Education and must be licensed in the State in which the services are to be provided or be eligible for examination by the Maine Board of Social Work Licensure, as documented by written evidence from such board.

E.Licensed Professional Counselor

A licensed professional counselor must be licensed in the State in which services are to be provided as documented by written evidence.

F.Alcohol and Drug Counselor

A licensed alcohol and drug counselor must be licensed by the State Board of Substance Abuse Counselors in the State in which services are to be provided and possess written evidence of such licensure.

G. Registered Nurse

A registered nurse must have a current and valid license as a registered professional nurse in the State in which services are to be provided as documented by written evidence.

H. Licensed Clinical Professional Counselor (LCPC)

A licensed clinical professional counselor must be licensed in the state in which services are to be provided as documented by written evidence.

I.Psychologist

A psychologist must be licensed or conditionally licensed by the Maine State Board of Examiners of Psychologists to practice as a psychologist.

J.Respiratory Therapist

A respiratory therapist must be currently licensed by the Maine Board of Respiratory Care Practitioners to practice as a licensed respiratory therapist.

K.Nurse-Midwife

"Nurse-midwife" means a professional who is a graduate of a Nurse-Midwife program approved by the American College of Nurse-Midwives and who is currently licensed to practice in the State as a registered professional nurse and who is legally authorized under State law and regulations to practice as a nurse-midwife. A nurse-midwife furnishes services within the scope of practice authorized by State law or regulation.

L.Other Qualified Staff

Qualifications of any other staff must be in accordance with all other applicable sections of the MaineCare Benefits Manual.

3.06-2. Supervision by a Physician Medical services rendered under this policy must be provided under the supervision of a physician. Nurse practitioners who have completed a minimum of 24 months supervision by a licensed physician and nurse-midwives are not subject to supervision by a physician. Psychologists, LCSWs, LCPCs and other non-medical staff are also not subject to the supervision of the physician. Physician supervision must be performed in accordance with the Maine Board of Licensure in Medicine or the Maine Board of Licensure in Osteopathy and the Maine State Board of Nursing requirements.

3.06-3Patient Records

There shall be a specific record for each patient that shall include, but not necessarily be limited to:

A. The patient's name, address, and birth date;

B. The patient's social and medical history, as appropriate;

C. Long and short range goals, as appropriate;

D. A description of any tests ordered and performed and their results;

E. A description of treatment or follow-up care and dates scheduled for revisits;

F. Any medications and/or supplies dispensed or prescribed;

G. Any recommendations for and referral to other sources of care;

H. The dates on which all services were provided;

I. Written progress notes, which shall identify the services provided and progress toward achievement of goals; and

J. A description of the findings from the physical examination.

Entries are required for each service billed and must include the name, title, and signature of the service provider.

3.06-4Program Integrity

A. Program Integrity monitors the medical services provided and determines the appropriateness and necessity of the services.

B. The Department and its professional advisors regard the maintenance of adequate clinical records as essential for the delivery of quality care. In addition, providers should be aware that clinical records are key documents for post-payment audit. In the absence of proper and complete clinical records, no payment will be made and payments previously made may be recovered in accordance with Chapter I of this Manual.

C. Upon request, the provider must furnish to the Department, without additional charge, the client's records, or copies thereof, corresponding to and substantiating services billed by that provider.

D. The Department requires that clinical records and other pertinent information shall be transferred, upon request and with the client's signed release of information, to other clinicians involved in the client's care.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-3, subsec. 144-101-II-3.06