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-60.04 - PROVIDER REQUIREMENTS

Universal Citation: 10 ME Code Rules § 144-101-II-60.04

Current through 2024-38, September 18, 2024

Providers of Medical Supplies and DME are enrolled MaineCare providers that:

A. Have executed a MaineCare Provider Agreement with the Department of Health and Human Services and have obtained a provider identification number from the Department;

B. Provide Medical Supplies and/or DME services to MaineCare members; and

C. Have a storefront located in Maine or within fifteen (15) miles of the Maine border in New Hampshire with a commercial address for the sales and service of the supplies and equipment sold, rented, or otherwise provided to members and regularly staffed operating hours. Providers must post hours of operation in a visible location for the general public and not be solely a sales representative for a manufacturer of DME or Medical Supplies.

D. Hearing Aids only: In addition to the requirements above, hearing aids, accessories, and repairs must be provided by an individual licensed by the State of Maine as an audiologist or as a licensed hearing aid dealer & fitter.

The following exceptions apply:

1. DME and supplies provided to a member who is residing out of state, only for the purposes of meeting an emergency medical need, with PA, at the discretion of the Department, taking into account cost effectiveness and medical necessity and only if the item(s) cannot be supplied by a MaineCare enrolled provider;

2. A provider who is the sole provider of a type of cost-effective, medically necessary DME may be enrolled only for the purpose of providing that item with PA. The provider must warranty the item for parts and labor.

3. The Department reserves the right to issue a request for proposals for provision of any supply or piece of equipment, and the resulting contract may be awarded to an out-of-state provider. The Department may enter into a special purchasing arrangement with one or more vendors capable of providing services to MaineCare members without the vendor having a physical storefront.

4. The Department may waive the requirement for providers to have a storefront in Maine or within fifteen (15) miles of the border if the Department, in its sole discretion, determines that waiving that requirement is in the best interests of the MaineCare program.

5. The Department will waive the requirement to have a storefront in Maine or within fifteen (15) miles of the border for audiologists operating outpatient services that are not enrolled as a DME provider and manufacturers of specialty modified low protein foods and formulas for the purpose of billing the Department as the supplier of prescription metabolic foods.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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