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 IV
Sec2 144-101-IV-1 - Restriction Plans
Subsection 144-101-IV-1.05 - EMERGENCY HEALTH CARE SERVICES AND NON-PRIMARY CARE PROVIDERS
Current through 2024-38, September 18, 2024
Non-primary care providers shall be reimbursed for health care services only in the following circumstances:
A. When the need to stabilize an emergency medical condition (as defined in Section 1.02-4.B. & C., Chapter I of the MaineCare Benefits Manual, also refer to Chapter IV, Section 1.03-5) exists. Reimbursement is subject to the provider's later written or verbal verification of that need when requested by the Program Integrity Unit;
B. When the member has been referred by the primary care provider; and
C. When the member has received services without a referral from providers whose category of service is not covered by the restriction plan, i.e., x-ray, laboratory, and optometrists.
