C.M.R. 14, 193, ch. 6A, subch. PNMI

Current through 2024-51, December 18, 2024

Subchapter - PNMI

SUMMARY: These regulations describe the licensing standards for Private Non-Medical Institutions (PNMIs) which can be either providers of community supports (CS) or residential services (RS). These PNMIs are separately licensed for purposes of identifying them as providers who bill MaineCare under Section 97 for private non-medical institution services and are required to meet special requirements. These regulations become effective retroactive to July 1, 2004.

GENERAL PROVISIONS: PRIVATE NON-MEDICAL INSTITUTIONS

A Private Non-Medical Institution (PNMI) licensed under this chapter is a MaineCare provider that is required to meet special requirements to provide either Community Supports (CS) or Residential Services (RS). In addition to surveying for compliance with the core standards, except as noted below, an agency providing PNMI services will also be surveyed according to the services they provide. In this way, an agency is given a tailored survey that reviews the full scope of their services.

PNMI services may include supported housing, residential programs, or intensive in-home supports. These services may be provided at an individual or scattered sites. For purposes of this subchapter, a PNMI means a person licensed by the Department of Health and Human Services to provide PNMI services to four or more MaineCare and other residents in single or multiple facilities under a written agreement with the State of Maine. A PNMI shall not be a health insurance organization, hospital, nursing home or community health care center.

PNMI services may also include community residences for persons with mental illness for the integrated treatment of persons with dual disorders, which provide mental health and substance abuse treatment services to individuals with coexisting disorders of mental illness and substance abuse. These residences shall be licensed as provided herein and must also be receiving funds from the Department of Health and Human Services for the treatment of persons with dual disorders. For PNMI services provided in scattered site apartments or in a client's own home, a provider shall not be required to comply with GOV.11, HS.4, HS.5, PHY.2 or PHY.3, insofar as those standards would affect the apartment or home.

All PNMIs licensed under this subchapter shall provide the Department with evidence of compliance with PNMI tax reporting requirements. The provider must have a provider agreement on file with the Department of Health and Human Services, Bureau of Medical Services.

Providers must also contract with the Department of Health and Human Services and satisfactorily meet all contract and provider agreement provisions.

A PNMI provider is permitted under the rules to provide certain types of services using appropriately qualified staff. Direct services include, but are not limited to, the following: physician services; psychiatrist services; psychologist services; psychological examiner services; social worker services; licensed clinical professional counselor services; licensed professional counselor services; dentist services; registered nurse services; licensed practical nurse services; psychiatric nurse services; speech pathologist services; licensed alcohol and drug counselor services; occupational therapy services; other qualified mental health staff services; other qualified medical and remedial staff services; other qualified alcohol and drug treatment staff services; personal care services; interpreter services; nurse practitioner services, physician assistant services; clinical consultant services; physical therapy services.

The above services must be provided by the following licensed or registered professional staff members: dentists, licensed alcohol and drug counselors, licensed clinical professional counselors, licensed professional counselors, nurse practitioners, occupational therapists, physicians, physician assistants, licensed practical nurses, psychiatrists, psychiatric nurses, psychologists, psychological examiners, registered nurses, social workers, or speech language pathologists. All providers must hold appropriate licensure in the State or Province in which services are provided and must practice within the scope of these licensing guidelines. Clinical consultant services must be provided by licensed or certified professionals within all State and Federal regulations specific to the services provided.

Other staff may be considered qualified for purposes of this rule if they meet the following requirements:

1. they have the education, training or experience that qualifies them to perform certain specified mental health functions;

2. they receive certification from the Department of Health and Human Services, or its designee, that they are qualified to perform such functions and such verification is recorded in writing and kept in the files or the Department or its designee; and

3. they perform such functions under the supervision of a licensed, certified or registered health professional with the supervisory relationship have been described to and approved by the Department in accordance with its licensing and certification rules.

Personal care service staff may be considered qualified for purposes of this rule if they perform personal care services and have met minimum training requirements set by the Department for the provision of personal care services in community residences for people with mental illness.

It is the responsibility of the PNMI provider to coordinate PNMI services with "in-home" and other services to address the full range of the client's needs. The PNMI provider shall not arrange for others to provide services which duplicate PNMI services included in the facility's PNMI rate. In order to avoid duplication of services, staff providing case management services as part of PNMI treatment shall coordinate their services with case managers providing services outside the residential setting.

A PNMI is subject to the surveillance and utilization review provisions set out in the MaineCare Benefits Manual, Chapter I. Any required time studies shall be done in accordance with the MaineCare Benefits Manual, 10-144 C.M.R. Ch. 101, and shall be documented in the facility.

SPECIFIC PROVISIONS: Private Non-Medical Institutions-Community Supports (PNMI-CS)

These standards, in addition to the core standards, are applied to agencies providing community support services for clients with severe and disabling mental illness, and include case management, outreach, assistance in meeting basic needs, direct skill teaching (activities of daily living, social skills, etc.), assistance, consultation, education, advocacy, and supportive counseling. Community support functions include developing service agreements, participation in hospital discharge meetings providing personalized support to clients, and participation in crisis intervention and resolution.

Access

CS.1 The agency has policies and procedures governing the establishment of a waiting list which minimally includes the following: prioritizing clients, selecting clients from the waiting list, and referring to other providers.

CS.2 Eligible individuals are informed of their right to receive an Individualized Support Plan and community support services and, when accepted or requested, receive them in a timely fashion.

CS.2.A. There is documented evidence that clients living in the community who apply and are eligible for services, are assigned a community support worker within three working days of application.

CS.2.A.1 When community support services cannot be assigned within three working days, the agency shall immediately notify the Commissioner in writing.

CS.2.B. There is documented evidence that an Individualized Support Plan is developed within 30 days of application.

CS.2.C. When a hospitalized client requests a community support worker, a worker will be assigned within one working day of receipt of the request from the hospital.

CS.2.C.1 The agency documents the date and time of the hospital's request;

CS.2.C.2 The agency documents the date and time the community support worker was assigned.

CS.2.D. There is documented evidence that individuals who decline the services of a community support worker or Individualized Support Plan are informed that they may apply for these services at any subsequent time.

CS.2.E. The agency will develop a policy and procedure and be able to demonstrate that the screening process for determination of eligibility for services is completed within 30 days of application.

CS.3 There are regular and scheduled outreach services available in the agency's service area.

CS.3.A Outreach contacts are documented and attempt to address the following:

CS.3.A.1 identifying information;

CS.3.A.2 an informal assessment of the individual's needs;

CS.3.A.3 the individual's level of commitment to initiate services; and

CS.3.A.4 an informal plan for engaging the individual further.

Interpretive Guideline for CS.3 through CS.3.A.4

For outreach services in general, informed consent for service provision should be obtained when an individual agrees to initiate services. Initiation of service is defined as the point when an individual agrees to have an outreach worker actively pursue services, other than information and referral, on their behalf.

Assessment

CS.4. A comprehensive assessment is conducted by an individual chosen or agreed to by the client, with the client's participation, within 30 days of the client agreeing to initiate services.

CS.4.A. The comprehensive assessment minimally addresses the following:

CS.4.A.1 the client's strengths and weaknesses;

CS.4.A.2 the client's perception of his or her needs;

CS.4.A.3 the family/guardian's input and perception of the client's needs when appropriate, and with the client's consent;

CS.4.A.4 a personal, family, and social history;

CS.4.A.5 the emotional, psychiatric and psychological strengths and needs of the client;

CS.4.A.6 a physical health status and history, including current prescribed and over-the-counter medication use and dental needs;

CS.4.A.7 past and current drug/alcohol use;

CS.4.A.8 a developmental history;

CS.4.A.9 possible sources of assistance and support in meeting the needs expressed by the client or legally responsible party, including state-and federal entitlement programs;

CS.4.A.10 physical and environmental barriers that may impede the client and family's ability to obtain services;

CS.4.A.11 history of physical and/or sexual abuse;

CS.4.A.12 the vocational, educational, social, living, leisure/recreation and medical domains; and

CS.4.A.13 potential need for crisis intervention services;

CS.4.A.14 housing and financial needs;

CS.4.A.15 the status of the Individualized Support Plan;

CS.4.A.15.a. in instances in which the Individualized Support Plan is the only service the client is receiving and there is no evidence of other immediately needed services, the worker will complete a preliminary assessment based upon the information in the worker's possession and, every 30 days subsequently, update the status of the ISP in a progress note. For these clients, the comprehensive assessment will be completed within 30 days of the completion of the ISP or the identification of an immediate service need; and

CS.4.A.16 the signature of the person who performed the assessment.

Interpretive Guideline for CS.4.A.1 thru CS.4.A.16

The Division of Licensing recognizes that in some cases not all of the information requested in these standards will be able to be obtained. The Division also recognizes that the level of detail required will vary given a variety of factors (the client's level of cooperation, the integrity of the information sources, the length of services or treatment, the condition being addressed, the practitioner's training, etc.). Although the Division will attempt to be sensitive to these factors and flexible in surveying this area, the agency should assure that assessments that do not address all these standards have accompanying documentation that justifies abbreviated or absent information.

CS.4.B. The agency will establish and adhere to policies and procedures establishing criteria for the performance of the following assessments:

CS.4.B.1 a nutritional assessment;

CS.4.B.2 a cognitive functioning assessment;

Interpretive Guideline for CS.4.B.2

The client's cognitive functioning assessment should include assessment of the following functions: problem solving, decision making, organization, self-direction, system negotiation skills, concentration, and abstract reasoning. For individuals over 60 years of age, this assessment should also include memory, language, orientation, and visuo-spatial abilities.

CS.4.B.3 an assessment of the client's capacity to make reasoned decisions; and

CS.4.B.4 a neurological assessment.

Interpretive Guideline for CS.4.B thru CS.4.B.4

These assessments do not necessarily have to be performed in the agency or by agency staff. The intent of these standards are to assure that the agency has mechanisms by which to evaluate the need for these assessments and to perform or refer for assessment those clients whose symptomatology suggests such need.

CS.4.C The assessment(s) shall be obtained from the client, legally responsible party, community service agencies, and to the extent possible, from other individuals in the community as authorized by the client or legally responsible party.

CS.4.D The client record contains a summary evaluation of the data collected in the comprehensive assessment.

CS.5 The agency has a documented policy and procedure on updating assessments that assures that assessments are current and in no case exceed annual updates.

Service Planning

CS.6 There is documented evidence that the service planning and revision process involves the client, legally responsible party, and other representatives and professionals whom the client designates.

Interpretive Guideline for CS.6

The client and legally designated guardian shall be fully and actively involved in the development or revision of the service plan, if possible. If the client consents, the client's designated representative, family members, or significant others shall be included in the development and revision of the service plan, unless contraindicated. When these individuals do not attend, their absence is noted. Each agency shall document good faith efforts, including at least 10 days notice of any service planning meetings, to involve guardians, representatives or legally responsible parents. In instances in which the agency is unable to provide 10 days notice, a written justification will be entered in the client's record.

CS.7 A service plan is developed for each client within 30 days of initiation of service, with the client, and based upon the wants and needs of the client identified in the comprehensive assessment and, if the client has one, the Individualized Support Plan.

CS.7.A. The service plan minimally contains the following:

CS.7.A.1 problem statements;

CS.7.A.2 short- and long-range goals based upon client needs with a projection of when such goals will be attained;

CS.7.A.3 objectives stated in terms which allow objective measurement of progress;

CS.7.A.4 multidisciplinary input and specification of treatment responsibilities;

CS.7.A.5 client input and signature;

CS.7.A.6 signatures of all people participating in the development of the plan;

CS.7.A.7 the methods and frequency of treatment, rehabilitation, support;

CS.7.A.8 a description of any physical handicap and any accommodations necessary to provide the same or equal services and benefits as those afforded non-disabled individuals; and

CS.7.A.9 criteria for discharge.

CS.7.B Justification for not addressing problems identified in the assessments is documented in the client record.

Interpretive Guideline for CS.7.B

The intent of this standard is to assure that the clinical staff considers all of the client's identified problems in formulating the service plan. Problems that are not reflected on the service plan should have accompanying documentation identifying the rationale for not addressing the problems at this time. This documentation can take many forms including progress notes, service plan narratives, etc.

CS.8 The service plan is designed so that the client's progress towards service plan goals can be monitored and evaluated.

Interpretive Guideline for CS.8

Service plans should have measurable goals and some means for reflecting when, or to what degree, a goal has been attained. The organization should also have mechanisms that document monitoring and evaluation of client goals, e.g., quality assessment, treatment plan review documents.

CS.9 The service plan is reviewed at major decision points in each client's treatment course, upon client request, and no less frequently than every 90 days.

Interpretive Guideline for CS.9

Major decision points may include, but are not necessarily limited to the following: when there is a change in the client's condition, when a service appears not to benefit the client, when the client is under- or over- utilizing services.

CS.10 Unmet service needs are documented in the service plan and in Interim plans subsequent to the service planning process.

Interpretive Guideline for CS.10

If at the time of or subsequent to the service planning meeting, team members know, on the basis of reliable information, that the needed services are unavailable, they shall note them as "unmet service needs" on the service plan and develop an interim plan based upon available services that meet, as nearly as possible, the actual needs of the client. The organization should also document notification of the organization's leaders and the Commissioner regarding the unavailability of service that is causing the unmet need.

CS.11 The agency has a policy and procedure for providing clients with a copy of their service plan within one week following its formulation, review or revision and notification of client recourse should they disagree with any aspect of the plan.

CS.11.A. There are no instances in which the agency fails to provide a copy of the client's service plan and/or notify them of recourse should they disagree.

Service Delivery

CS.12 Community support workers assist clients in negotiating linkages with service providers as evidenced by documentation that reflects each contact and the delivery of those services deemed appropriate in the client's service and support plans.

Discharge Planning

CS.13 Each client record contains documentation of current discharge or termination planning.

CS.14 The agency has discharge planning policies and procedures.

CS.14.A The agency has a policy and procedure for determining when a client is considered 'inactive'.

CS.14.A.1 The inactive status policy and procedure notes what documentation is kept on the client during inactive status.

CS.14.A.2 The inactive status policy and procedure notes the duration of inactive status before the case is considered closed.

CS.15 A discharge summary is entered in the client record within 15 days of discharge or on the 90th day of inactive status and includes the client's course of treatment and ongoing needs at discharge.

CS.15.A. Each discharge summary minimally addresses, but need not be limited to the following:

CS.15.A.1. the reasons for termination of service;

CS.15.A.2. the final assessment, including the general observations and significant findings of the client's condition initially, while services are being provided and at discharge;

CS.15.A.3. the course and progress of the client with regard to each identified problem; and

CS.15.A.4. the recommendations and arrangements for further continued service needs.

Interpretive Guideline for CS.15

For clients on inactive status, a discharge summary should be completed no later than 90 days following placement on inactive status or earlier given the following conditions:

1. another agency submits a request for the client's discharge summary prior to the 90th day of inactive status;

2. agency policy requires that a discharge summary be completed earlier than the 90th day of inactive status; and

3. practitioners who are leaving agency employment must complete discharge summaries on all of their inactive status clients regardless of time frame.

CS.16 The agency has policies and procedures that specify under what conditions services may be discontinued or interrupted which minimally include how and when the client is notified.

CS.16.A. For agencies serving DHHS class members, the agency shall first obtain prior written approval for discontinuing or interrupting services from the Department.

CS.16.B For agencies serving DHHS class members, the agency shall give thirty days advance written notice to the client and the client's guardian. If the client poses a threat of imminent harm to persons employed or served by the agency, the agency shall give notice that is reasonable under the circumstances.

CS.16.C. For agencies serving DHHS class members, the agency shall give such notice as may be required by law or regulation.

CS.16.D For agencies serving DHHS class members, the agency shall assist the client in obtaining the services from another agency.

CS.16.E For agencies serving DHHS class members, the agency shall provide documented evidence in the client record of compliance with these standards, through letters, progress notes, phone logs, and/or facsimile.

CS.17 Applicants who are not eligible for services will be referred to appropriate services, if required, available and desired.

CS.17.A. The agency has a policy and procedure on referral and/or transfers of individuals deemed inappropriate for services offered by the agency that minimally includes communicating the rationale for the referral/transfer to the applicant and providing them with a list of alternative service providers and advocacy services.

CS.17.B. The agency provides and documents other assistance as required to assist the individual to obtain/access the services to which they are referring him/her.

Health

CS.18 If food services are provided, the facilities for the preparation and serving of food shall be inspected and approved by the Department of Health and Human Services.

CS.18.A. If food is either prepared or served at the facility, then the agency shall either obtain a Department of Health and Human Services (DHHS) Eating Establishment license or show written evidence from DHHS indicating that they do not need such a license.

CS.18.B. When the agency requires a DHHS license, the agency's Eating Establishment license is current.

CS.19 The agency shall have methods for obtaining on- or off-site medical services for all clients.

CS.19.A. The agency defines in policy and procedure those medical services delivered on-site. For those medical services not provided on-site, letters of agreement and/or procedures for accessing medical service provider(s) are in effect.

Human Resource Management

CS.20 There is documented evidence that community support workers are licensed or certified to deliver mental health services as approved by the Division of Licensing at DHHS.

CS.21 Community support workers shall have a maximum of 40 clients in their caseload.

CS.21.A. For purposes of this standard, individual clients who present a multiplicity of needs, who have recently required crisis intervention and resolution services or who have a need for especially intense community support shall, for purposes of computing the above ratio, be counted as 2.5 clients.

CS.21.B. In instances in which the agency has compelling reasons for not meeting this standard, those reasons will be documented as well as efforts being taken to achieve compliance with the standard.

Private Non-Medical Institutions-Residential Services (PNMI-RS)

These standards, in addition to the core standards, are applied to agencies providing residential services.

Access

RS.1 The agency has policies and procedures governing the establishment of a waiting list, that minimally includes the following: prioritizing clients, selecting clients from the waiting list, and referring clients to other providers.

RS.1.A. Policies and procedures governing the establishment of waiting lists and the selection of clients will be in compliance with the Fair Housing Amendments Act.

Assessment

RS.2 A comprehensive assessment is conducted by an individual chosen or agreed to by the client or legally responsible party, with the client's participation, within 20 working days of the client's admission.

RS.2.A. The comprehensive assessment minimally addresses the following:

RS.2.A.1 the client's strengths and weaknesses;

RS.2.A.2 the client's perception of his or her needs;

RS.2.A.3 the family/guardian's input and perception of the client's needs when appropriate, and with the client's consent;

RS.2.A.4 a personal, family, and social history;

RS.2.A.5 the client's emotional, psychiatric and psychological strengths and needs;

RS.2.A.6 a physical health status and history, including current prescription and over-the-counter medication use;

RS.2.A.7 past and current drug/alcohol use;

RS.2.A.8 a developmental history;

RS.2.A.9 possible sources of assistance and support in meeting the needs expressed by the client or legally responsible party, including state and federal entitlement programs;

RS.2.A.10 physical and environmental barriers that may impede the client and family's ability to obtain services;

RS.2.A.11 history of physical and/or sexual abuse;

RS.2.A.12 the vocational, educational, social, living, leisure/recreation and medical domains;

RS.2.A.13 potential need for Crisis Intervention Services;

RS.2.A.14 housing and financial needs;

RS.2.A.15 status of the Individualized Support Plan; and

RS.2.A.16 the signature of the person who performed the assessment.

Interpretive Guideline for RS.2.A.1 thru RS.2.A.13

RS.2.B. The agency will establish policies and procedures establishing criteria for the performance of the following assessments:

RS.2.B.1 a nutritional assessment;

RS.2.B.2 a cognitive functioning assessment;

RS.2.B.3 an assessment of the client's capacity to make reasoned decisions;

RS.2.B.4 a neurological assessment.

Interpretive Guideline for RS.2.B.2

Interpretive Guideline for RS.2.B thru RS.2.B.4

RS.2.C The assessment(s) shall be obtained from the client, legally responsible party, community service agencies, and to the extent possible, from other individuals in the community as authorized by the client or legally responsible party.

RS.2.C.1. In instances in which the client receives community support services and/or has an Individualized Support Plan, the agency will, subject to the client's consent, attempt to coordinate the assessment and subsequent service planning with the community support provider.

RS.2.C.1.a. Services provided to these clients will be consistent with the targets and objectives of the Individualized Support Plan.

RS.2.C.1.b. Services provided to these clients will be delivered pursuant to a service agreement negotiated with the community support worker.

RS.2.D The client record contains a summary evaluation of the data collected in the comprehensive assessment.

RS.3 The agency has a documented policy and procedure on updating assessments that assures that assessments are current and in no case exceed annual updates.

Service Planning

RS.4 An initial service plan is developed within 72 hours following admission and is based on preliminary assessment findings.

RS.5 There is documented evidence that the service planning and revision process involves the client, legally responsible party, and other representatives and professionals whom the client identifies.

Interpretive Guideline for RS.5

The client and legally designated guardian shall be fully and actively involved in the development or revision of the service plan, if possible. If the client consents, the client's designated representative, family members, or significant others shall be included in the development and revision of the service plan, unless contraindicated. When these individuals do not attend, their absence is noted. Each agency shall document good faith efforts, including at least 24 hour notice of any service planning meetings, to involve guardians, representatives or legally responsible parents.

RS.6 A comprehensive service plan is developed for each client with the client's consent and within 20 working days of admission.

RS.6.A. The comprehensive service plan minimally contains the following:

RS.6.A.1 problem statements;

RS.6.A.2 short- and long-range goals based upon client needs with a projection of when such goals will be attained;

RS.6.A.3 objectives stated in terms which allow objective measurement of progress;

RS.6.A.4 multidisciplinary input and specification of treatment responsibilities;

RS.6.A.5 client input and signature;

RS.6.A.6 signatures of all people participating;

RS.6.A.7 the methods and frequency of treatment, rehabilitation, support;

RS.6.A.8 a description of any physical handicap and any accommodations necessary to provide the same or equal services and benefits as those afforded non-disabled individuals; and

RS.6.A.9 criteria for discharge or release to a less restrictive setting.

RS.6.B Justification for not addressing problems identified in the assessments is documented in the client record.

Interpretive Guideline for RS.6.B

RS.7 The service plan is designed so that the client's progress towards service plan goals can be monitored and evaluated.

Interpretive Guideline for RS.7

RS.8 The service plan is reviewed at major decision points in each client's treatment course, upon client request, and no less frequently than every 90 days.

Interpretive Guideline for RS.8

RS.9 Unmet service needs are documented in the service plan.

Interpretive Guideline for RS.9

If at the time of the service planning meeting, team members know on the basis of reliable information that the needed services are unavailable, they shall note them as "unmet service needs" on the service plan and develop an interim plan based upon available services that meet, as nearly as possible, the actual needs of the client. The organization should also document notification of the organization's leadership and the Commissioner regarding the unavailability of service that is causing the unmet service need.

RS.10 The agency has a policy and procedure for providing clients with a copy of their service plan within one week following its formulation, review or revision and notification of client recourse should they disagree with any aspect of the plan.

RS.10.A. The agency will not fail to provide a copy of the client's service plan and/or notify them of recourse should they disagree.

Discharge Planning

RS.11 Each client record contains documentation of current discharge or termination planning, if appropriate.

RS.11.A. Planning for discharge to another setting or service will be contingent upon the client's consent to the establishment of such a discharge as a goal.

RS.12 A discharge summary is entered in the client record within 15 days of discharge and includes the client's course of treatment and ongoing needs at discharge.

RS.12.A. Each discharge summary minimally addresses, but need not be limited to the following:

RS.12.A.1 the reasons for termination of service;

RS.12.A.2 the final assessment, including the general observations and significant findings of the client's condition initially, while services were being provided and at discharge;

RS.12.A.3 the course and progress of the client with regard to each identified problem; and

RS.12.A.4 the recommendations and arrangements for further continued service needs.

RS.13 The agency has policies and procedures that specify under what conditions services may be discontinued or interrupted which minimally include how and when the client is notified.

RS.13.A. For agencies serving DHHS class members, the agency shall first obtain prior written approval for discontinuing or interrupting services from the Department.

RS.13.B For agencies serving DHHS class members, the agency shall give thirty days advance written notice to the client and the client's guardian. If the client poses a threat of imminent harm to persons employed or served by the agency, the agency shall give notice that is reasonable under the circumstances.

RS.13.C For agencies serving DHHS class members, the agency shall give such notice as may be required by law or regulation.

RS.13.D For agencies serving DHHS class members, the agency shall assist the client in obtaining the services from another agency.

RS.13.E For agencies serving DHHS class members, the agency shall provide documented evidence in the client record of compliance with these standards, through letters, progress notes, phone logs, and/or facsimile.

RS.14 The agency will have a discharge protocol that protects the client from summary discharge and allows the agency to maintain program integrity.

RS.14.A. The agency has a policy and procedure for discharging clients that include the terms upon which a client may be discharged (e.g., disciplinary reasons, under-utilization of the program).

RS.14.B. Except in emergency cases, clients shall be given 30 days notice before discharge.

RS.14.C. The agency will not summarily discharge clients. All substantiated complaints will be assessed for the seriousness of the violation and actions taken to achieve compliance.

RS.15 The agency documents the client's stated preference for living situation in the discharge plan.

Interpretive Guideline for RS.15

When the client's preference for living situation cannot be accommodated, the reasons are documented.

RS.16 Applicants who are not eligible for services will be referred to appropriate services, if required, available and desired.

RS.16.A. The agency has a policy and procedure on referral and/or transfers of individuals deemed inappropriate for services offered by the agency that minimally includes communicating the rationale for the referral/transfer to the applicant and providing them with a list of alternative service providers and advocacy services.

RS.16.B. The agency provides and documents other assistance as required to assist the individual to obtain/access the services to which they are referring him/her.

Health

RS.17 If food services are provided, the facilities for the preparation and serving of food shall be inspected and approved by the Department of Health and Human Services (DHHS).

RS.17.A If food is either prepared or served at the facility, then the agency shall either obtain a DHHS Eating Establishment license or show written evidence from DHHS indicating that they need no such license.

RS.17.B. When the agency requires a DHHS license, the agency's Eating Establishment license is current.

RS.18 The agency shall have methods for obtaining on- or off-site medical services for all clients.

RS.18.A. The agency defines in policy and procedure those medical services delivered on-site. For those medical services not provided on-site, letters of agreement and/or procedures for accessing medical service provider(s) are in effect.

Physical Plant

RS.19 A secure and readily accessible storage area of adequate size is available to accommodate client belongings.

RS.19.A. The agency has a policy and procedure related to what personal belongings may be brought to the agency.

Residential Services

RS.20 Residential service agencies provide or arrange for comprehensive treatment, training and support of clients.

RS.20.A. Residential service agencies provide or arrange for support and training in the following areas:

RS.20.A.1 housekeeping and home maintenance skills;

RS.20.A.2 mobility and community transportation skills;

RS.20.A.3 interpersonal relationships, including spouse, family and friends;

RS.20.A.4 health maintenance, including personal hygiene, exercise and fitness, nutrition and diet management, and use of medical services and medicine;

RS.20.A.5 safety practices, including dealing with injuries and life threatening emergencies;

RS.20.A.6 financial management, including techniques of client purchasing, banking, taxes, budgeting and repaying debts;

RS.20.A.7 basic academic skills;

RS.20.A.8 management of personal and legal affairs;

RS.20.A.9 contingency planning, problem-solving, decision-making;

RS.20.A.10 self-advocacy and assertiveness training;

RS.20.A.11 utilization of community services and resources, including laundromats, library, post office, client affairs offices, etc.

RS.20.A.12 recreational and leisure time activities;

RS.20.A.13 work attitude and skills exploration;

RS.20.A.14 menu planning and meal preparation;

RS.20.A.15 use of the telephone;

RS.20.A.16 human sexuality; and

RS.20.A.17 client affairs and rights, including familiarity with warranties, policies and procedures of governmental and community service agencies.

Interpretive Guideline for RS.20.A through RS.20.A.17.

For providers of children's residential services, these topics will be addressed as applicable on an age appropriate basis.

C.M.R. 14, 193, ch. 6A, subch. PNMI