C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-43, subsec. 144-101-II-43.06

Current through 2024-51, December 18, 2024

Subsection 144-101-II-43.06 - DURATION OF CARE

43.06-1Member Service Provision Rights

Receipt of hospice services in no way affects the rights afforded to residents of a nursing facility under Chapter II, Section 67, including those relating to transfer and discharge, status change notification and hearings and appeals.

The election of hospice by a member, however, in no way diminishes the responsibility of the member or nursing facility to obtain required prior authorization, or to comply with eligibility requirements for nursing facility placement.

43.06-2Member Status Change

A. The billing provider must notify the Department of the following changes in consumer status:

1. Admission to or discharge from a nursing facility

2. Transfer from one nursing facility to another

3. Entry into or exit from hospice status

4. Transfer from one hospice to another

5. Member death.

B. As applicable, the following forms must be used:

1. Notice of Consumer Transfer/Death BMS/CS 34

2. Election/Revocation of Hospice

3. Certification of Terminal Illness

C.Hospice enrollee in a nursing facility (NF)

This section delineates who is responsible for submitting notification for hospice members who are in a NF.

1. When the change of status involves only the nursing facility, the NF must submit information as outlined in Chapter II, Section 67, of the MBM.

2. When the change of status involves only the hospice (including, but not limited to, election/ revocation) the hospice must submit the appropriate election or revocation form.

3. When the change of status is a transfer from one hospice to another, the hospice to which the member is moving must submit the BMS 34 form.

4. When the change of status involves both the hospice and the nursing facility (e.g. member death) the NF is responsible for submitting the BMS 34 form.

D.Members who are in hospice only

When the change of status is a transfer from one hospice to another, the hospice to which the member is moving must submit the BMS 34 form.

43.06-3Professional and Other Qualified Staff

The hospice is responsible for the verification of appropriate licensure, certification or other qualifications of hospice staff, and for monitoring service providers. The hospice must maintain documentation of qualifications of service providers.

Staff must meet orientation and training requirements outlined in hospice licensing regulations.

A. The following professionals, employed directly or by contract with a hospice, by virtue of possession of a current license to practice their discipline in the State of Maine or state or province in which the service is provided, may provide hospice services within the scope of their license:

1. Physician

2. Physician Assistant

3. Registered Nurse

4. Practical Nurse

5. Clinical, Dietary and Pastoral Counselors

6. Physical Therapist

7. Physical Therapist Assistant

8. Occupational Therapist Registered (OTR)

9. Certified Occupational Therapy Assistant (COTA)

10. Medical Social Worker

11. Speech-Language Pathologist

12. Speech-Language Pathology Assistant

B. The following staff, employed directly or by contract with a hospice, may provide hospice services within the scope of their license or certification when they meet the following requirements:

1.Certified Home Health Aide and Certified Nursing Assistant (CNA)

A CNA or home health aide must be listed on the Maine Registry of Certified Nursing Assistants. A CNA or home health aide must be supervised as required by licensing regulations.

2.Other Qualified Staff

Other qualified staff are staff members, other than those defined above, who have been determined competent by a health care professional and documented by the hospice to have appropriate education, training and experience for the task in the plan of care for which they have been hired.

43.06-4Written Plan of Care

A plan of care must be established before services are provided. The plan of care must be established by the member's Attending Physician, the hospice physician, and the Interdisciplinary Team. Services must be consistent with the plan of care to be reimbursed. The hospice must designate a registered nurse, whose responsibility it is to coordinate the implementation of the plan, and to provide assurance that the member receives necessary care and services on a 24-hour basis. The plan must be established on the same day as the assessment if the day of assessment is to be a covered day of hospice care.

43.06-5Member Record

All hospices must maintain a clinical record for each member receiving care and services. The clinical record must include the following information:

A. The plan of care;

B. The member's name, MaineCare ID, address, sex, age, and next of kin;

C. Election/Revocation forms;

D. Pertinent medical history;

E. Certification of Terminal Illness; and

F. Complete documentation of all services and events, including: assessments, progress notes and reviews of the plan of care. Progress notes must be maintained in conformance with Medicare conditions of participation.

43.06-6Surveillance and Utilization Review

The Department shall perform the Surveillance and Utilization Review activities set forth in Chapter I, General Administrative Policies and Procedures, of the MBM.

Upon request, the provider will furnish to the Department, with no additional charge, the clinical records, or copies thereof, corresponding to and substantiating services billed by that provider.

43.06-7Electronic Visit Verification

Effective July 1, 2024, all Hospice Services provided in-home are subject to the following requirements:

A. Providers must utilize the Department's Electronic Visit Verification (EVV) system at no cost or procure and utilize their own EVV system, so long as the Department's EVV system can accept and integrate data from the provider-owned EVV system and the provider-owned system is otherwise compatible with the Department's system and billing guidelines.

B. Visits conducted as part of such services shall be electronically verified with respect to:

1. Type of service performed;

2. Individual receiving the service;

3. Date of the service;

4. Location of the service;

5. Individual providing the service; and

6. Time the service begins and ends.

C. Hospice Services delivered in facility settings are exempt from EVV requirements.

D. Physician Services are delivered and billed as described in Section 90, and are exempt from EVV requirements.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-43, subsec. 144-101-II-43.06