Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-13 - TARGETED CASE MANAGEMENT SERVICES
Subsection 144-101-II-13.04 - DURATION OF CARE
Current through 2024-38, September 18, 2024
Each eligible member may receive covered services that are medically necessary within the limitations of this section. The Department reserves the right to request additional information to evaluate medical necessity and review utilization of services. The Department will require prior authorization (PA) for some targeted case management services reimbursed under this section (refer to 13.07-2). The Department may require utilization review for all services reimbursed under this section. Providers must work with the Department or its Authorized Agent to provide this information.
Members may receive case management services for as long as they meet the general criteria for eligibility described above and the specific criteria in the appropriate sections, below.
Case management services will discontinue if:
1. The member or legal guardian no longer desires case management services; or
2. The member is no longer eligible to receive benefits pursuant to 13.03.
