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-15 - Chiropractic Services
Subsection 144-101-II-15.02 - DEFINITIONS

15.02-1 Chiropractic Services are those services provided to a member by a licensed chiropractor.

15.02-2 Chiropractor is an individual who both is licensed by the state or province in which he/she provides chiropractic services and meets uniform minimum standards promulgated by the Secretary of Health and Human Services under 42 U.S.C. § 1395x(r) and 42 C.F.R. 440.60.

15.02-3 Rehabilitation Potential is a documented expectation by the member's primary care provider or prescribing provider (Medical Doctor (MD), Doctor of Osteopathic (DO), Physician Assistant (PA), or Advanced Practice Registered Nurse (APRN)), who is licensed and acting within the scope of his or her license, indicating that the member's condition will improve significantly in a reasonable, predictable period of time as a result of the prescribed treatment plan.

15.02-4 Prior Authorization is the process of obtaining prior approval from the Department as to the medical necessity and eligibility for certain MaineCare services before they are delivered, as set forth herein and in Chapter I, Section 1 of the MaineCare Benefits Manual (MBM).