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-60 - Medical Supplies and Durable Medical Equipment
Subsection 144-101-II-60.01 - DEFINITIONS
Current through 2024-38, September 18, 2024
60.01-1 Activities of Daily Living (ADL) are those activities related to personal care including but not limited to: showering, bowel/bladder management, eating, functional mobility, personal device care (hearing aids, etc.), personal hygiene, and toileting.
60.01-2 Adjusted Acquisition Cost is the lowest price paid to a supplier by an eligible provider for Durable Medical Equipment or medical/surgical supplies after adjustments for quantity discounts, any prompt payment discounts and excluding all associated costs, including but not limited to, shipping, freight, handling, and insurance costs. Wheelchair providers need not adjust the price paid to a supplier based on any prompt payment discount.
60.01-3 Department is the Maine Department of Health and Human Services.
60.01-4 Durable Medical Equipment (DME) is:
All four (4) of the above criteria must be met for coverage under this Section. Specific definitions and criteria are located on the MaineCare Health PAS Online Portal.
Home/Environmental modifications do not meet the definition of medical supplies or DME and are not covered under this Section.
60.01-5 Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) is a facility that meets State licensing and Federal certification requirements for ICFs-IID.
60.01-6 Medical Supplies are those Medical Supplies that are primarily needed to relieve or control a medical condition. Examples of supplies not primarily needed to relieve or control a medical condition include, but are not limited to, room and underarm deodorants.
60.01-7 Nursing Facility (NF) means a Skilled Nursing Facility (SNF) in the Medicare program or a Nursing Facility (NF) in the MaineCare program which meets State licensing and Federal certification requirements for nursing facilities and has a valid agreement with the Department of Health and Human Services.
60.01-8 Prior Authorization (PA) is the process of obtaining prior approval as to the medical necessity and eligibility for a service.
60.01-9 Power Mobility Device (PMD) includes both integral frame and modular construction type Power Wheelchairs (PWCs) and power operated vehicles (POVs).
60.01-10 Power Operated Vehicle (POV) is a chair-like battery powered mobility device for people with difficulty walking due to illness or disability, with integrated seating system, tiller steering, and three or four-wheel non-highway construction.
60.01-11 Power Wheelchair (PWC) is a chair-like battery powered mobility device for people with difficulty walking due to illness or disability, with integrated or modular seating system, electronic steering, and four or more wheel non-highway construction.
60.01-12 Qualified Provider is a provider who is qualified by education, training, and licensure/regulation to perform services within his or her scope of practice.
