The Governing Body

The Governing Body

The Agency has a legally responsible Governing Body with written documentation of its source of authority, including a Certificate of Formation, EIN Declaration, and Operating Agreement. The Governing Body serves as the Agency Board of Directors and is comprised of the three owner-members of the LLC. All three members of the Board are residents of Maine, and all three will be actively engaged/employed in managing the day-to-day activities of the Agency.

Duties of the Governing Body

The primary obligation of the FIDELITY ADULT CARE LLC board members is to uphold the described requirements of provider participation in MaineCare Benefits Manual Ch 1 and Ch 2, Section 21 Waiver Programs for ICBS, including:

1. Maintain current licenses and apply for renewal at least 30 days prior to expiration.
2. Notify the Department when there are changes to basic information through https://mainecare.maine.gov.
3. Not interfere with Member decision-making or freedom of choice to seek care.
4. Not discourage accessing medically necessary care.
5. Allow freedom to reject medical care and treatment.
6. Not discriminate.
7. Provide services and supplies to members in the same quality and mode of delivery as the general public.
8. Charge and bill in amounts not to exceed the provider’s customary and usual charges.
9. Accept as payment the MaineCare rate as specified.
10. Bill only for covered services and supplies delivered.
11. Accept assignment of Medicare benefits for eligible MaineCare members.
12. Use designated HIPAA-compliant billing forms or accepted 837 transactions for submission of charges and follow MaineCare billing instructions.
13. Maintain and retain contemporaneous financial, provider, and professional records sufficient to document the nature, scope, and details of health care provided, fully and accurately, and/or related services or products provided to each individual MaineCare member.
14. Have safeguards and security measures in place that allow only authorized persons to enter information into electronic records. Passwords must be used that identifies the individual and the time and date of entry.
15. Maintain and retain contracts with subcontractors for at least five years.
16. Transfer clinical records at no charge.
17. Comply with DHHS regarding faxes and e-signatures.
18. Hold confidential and use for authorized program purposes only all MaineCare information regarding members.
19. Comply with this manual and federal and state law.
20. Enter into the MaineCare provider agreement.
21. Disclosure of ownership or control.
22. Provide adequate access to medically necessary covered health care services.
23. Refer to the department for any evidence demonstrating fraudulent or abusive provider and/or employee practice or overuse of member services.
24. Abide by provisions pertaining to the exclusions of individuals and entities from participation in MaineCare or Medicare (visit exclusions.oig.hhs.gov).
25. Maintain accurate, auditable, and sufficiently detailed financial and statistical records to substantiate cost reports, negotiated rates, by report items, or any other fee-for-service rate for a period of at least 5 years after the settlement of rate with the department.
26. Attend provider education sessions when required by DHHS.
27. Submit all claims for review prior to payment, when required by DHHS.
28. Comply with MaineCare Benefits Manual Section 21 and any other Chapters and Sections that may apply now or in the future.

Requirements For Participation In the MaineCare Program

Providers must comply with all requirements as outlined in Chapter 1 and Chapter 11, Section 21 of the MaineCare Benefits Manual. The primary obligation of the FIDELITY ADULT CARE LLC Board members is to uphold the described requirements of provider participation in the MaineCare Benefits Manual Section 21 Waiver Program for Home and Community-Based Settings.

Responsibilities of The Provider Agency

As a Qualified Provider Agency, FIDELITY ADULT CARE LLC is responsible for maintaining adequate financial and statistical records and making them available when requested for inspection by an authorized representative of the DHHS, Maine Attorney General’s Office, or the Federal Government.