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Integrity Unit Questions

1. When providing services and staff mention person-served participating in recreational activities like bowling and a movie is this considered a non- covered service.

Response: The purpose of the activity is not recreational. It is a therapeutic activity that allows the individual to get out into their community. The documentation should NOT say “Went bowling” but rather what the activity was and its therapeutic benefit and outcome. i.e. “John enjoys the activity, meets people appropriately, is learning to count money, etc…

 

2. When staff document in a subjective manner and do not write interventions and progress towards goals and objectives would this documentation be considered a non- billable service.

Response: Documentation that reflects information about the individual that is significant to report, i.e. John was ill all day and notes what staff did to support him is billable.
Notes that are vague and do not reflect supports provided are not acceptable.

 

3. What type of documentation is considered a non-billable service?

Response: Documentation that is not related to the person’s plan is a non-billable service.
For example: shovel the walkway. If this is the only note for the shift, it is not billable. Documentation must reflect direct services to the individual.

 

4. Do you have a checklist that would assist providers in assuring compliance with all standards? Including: Section 21, 24, 29 and Chapter 1 of the MaineCare Manual.

Response: There is no checklist. The basic list of requirements are found in Maine Care Manual 1.03-3

 

5. As a provider we request at this time a service plan and the PCP. The reason why that is the PCP components most times do not reflect the medical necessity of services. Our service plan indicate the areas that the individual needs support usually the first to goals and objective reference the reason for service such as safety or behavior management. Is this process still needed with the proposed section 21 regulations?

Response: Documentation needs to reflect the services provided. Repetitive services can be documented in a checklist with an occasional note to indicate how the activity is going (i.e. tooth brushing)

 

 

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