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 X
Sec2 144-101-X-4 - Limited Family Planning Benefit
Subsection 144-101-X-4.08 - REIMBURSEMENT

Universal Citation: 144-101-X-4 ME Code Rules § 144-101-X-4.08

Current through 2024-38, September 18, 2024

MaineCare reimbursement shall be made only for those family planning counseling, instruction and medical services which are provided directly to the member.

A. The maximum amount of payment for services rendered shall be the lowest of the following:

1. The provider's usual and customary charge.

2. Payment for services listed in the Limited Family Planning Benefit table (attached hereto as Appendix A) at the rate established by MaineCare as listed on the Department's rate-setting website: https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx.

3. The lowest amount allowed by Medicare Part B when such service is covered.

B. Family planning providers are reimbursed at the same fee-for-service rates as other providers of these services, including Section 90, "Physician Services," where applicable.

C. Family planning service providers, when furnishing covered services, shall be reimbursed for interpreter services provided to deaf/hard of hearing Enrollees when these services are necessary to communicate effectively with the Enrollees regarding health-care needs. Refer to the MaineCare Benefits Manual Chapter I for more information on interpreter services.

D. In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from any other sources that are available for payment of a rendered service prior to billing the MaineCare program.

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