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-9 - INDIAN HEALTH SERVICES
Subsection 144-101-II-9.01 - DEFINITIONS

09.01-1 Contract Health Services (CHS) means health services provided at the expense of the Indian Health Service from public or private medical or hospital facilities other than those of the Indian Health Service. [Title 42 CFR Section 136.21]

09.01-2 Covered Servicesare those services described in Section 9.04 for which payment may be made under Title XIX of the Social Security Act.

09.01-3 Direct Effect is any effect caused by a change or update in policy on a service tribes are reimbursed for through MaineCare Services. (Some examples of changes that would constitute direct effect are: changes "that are more restrictive for eligibility determinations, changes that reduce payment rates or changes in payment methodologies to I/T/U providers or for services reimbursed to I/T/U providers, reductions in covered services, changes in consultation policies, and proposals for demonstrations or waivers that may impact Indians or I/T/U providers.") (SMDL 10-001, January 22, 2010)

09.01-4 Indian Health Center is an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act as of October 1, 1991.

09.01-5 Indian Health Center Unit of Service is a visit that includes face-to-face contact with one or more of the clinic's professional staff and, where appropriate, provision of treatment, supplies, or laboratory services.

09.01-6 Indian Tribe, Tribal Organization, or Urban Indian Organization (I/T/U)means any of the following: an "Indian Tribe," meaning any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or group or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688, 43 U.S.C. §§ 1601 et seq.) which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians; a "Tribal Organization," meaning the elected governing body of any Indian tribe or any legally established organization of Indians which is controlled by one or more such bodies or by a board of directors elected or selected by one or more such bodies (or elected by the Indian population to be served by such organization) and which includes the maximum participation of Indians in all phases of its activities; or an "Urban Indian Organization," meaning a nonprofit corporate body situated in an urban center, governed by an urban Indian controlled board of directors, and providing for the maximum participation of all interested Indian groups.

and individuals, which body is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in §503(a) of the Indian Health Care Improvement Act (90 Stat. 1400, 42 U.S.C. §1653(a)) .