Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 505 - APPROPRIATENESS REVIEW PROCEDURES AND CRITERIA
Section 144-505-2 - SERVICES TO BE REVIEWED

Universal Citation: 10 ME Code Rules ยง 144-505-2

Current through 2024-38, September 18, 2024

A. Existing institutional health services will be reviewed by the Maine Health Systems Agency, Inc. according to the review schedule which follows. Completion dates shown in the following schedule represent, to the extent practicable, the date on which the MHSA Board of Trustees shall forward its recommendation to the Bureau of Health Planning and Development. The Bureau of Health Planning and Development will complete its review and publish its findings with respect to each scheduled institutional health service within one year of the receipt of an appropriate recommendation from the Maine Health Systems Agency, Inc., provided that the Agency completes its review on a timely basis. If the MHSA fails to make such a timely recommendation, the Bureau shall provide notice of the beginning of its review not later than 120 days after the scheduled completion of the MHSA's review as shown in the following schedule. If the MHSA subsequently completes its review of the scheduled institutional health service and forwards its recommendation with respect to the appropriateness of such services to the Bureau prior to the date on which the State agency makes its decision, the State agency will consider the MHSA's recommendation.

B. Schedules for Review

MHSA MHSA
Start Date End Date
Open Heart Surgery Services 11/1/80 4/30/81
Cardiac Catheterization Services 11/1/80 4/30/81
Megavoltage Radiation Therapy Services 2/l/80 7/31/81
Computerized Axial Tomographic
Scanning Services 2/l/81 7/31/81
End Stage Renal Dialysis Services 6/l/81 11/30/81
Neonatal Special Care Nurseries 8/1/81 1/31/82
Pediatric Care Services 8/1/81 1/31/82
Obstetrical Care Services 8/1/81 1/31/82
Intermediate Care Facilities 12/1/81 5/31/82
Skilled Nursing Facilities 12/l/81 5/31/82
Home Health Care Services12/l/81 5/31/82
Psychiatric Care Services 3/l/82 8/31/82
Chemical Dependency Services 3/l/82 8/31/82
ICU/CCU Service 7/l/82 12/11/82
Medical/Surgical Services 7/l/82 12/11/82

C. Definition of Services

1. open Heart Surgery Services. Services dealing with a class of highly technical operations on the heart and intrathoracic great vessels which requires temporary use of cardiopulmonary bypass equipment to perform the functions of circulation during surgery.

2. Cardiac Catheterization Services. Services associated with procedures for diagnosing disorders of the heart, lung, and the great vessels with the resource capability to insert catheters into the heart and adjacent great vessels, to reliably measure multiple parameters of cardiac physiological activity and to obtain visualization of the appropriate heart chambers and adjacent vessels.

3. Megavoltage Radiation Therapy Services. Services associated with a field within medicine which employs the use of high energy ionizing radiation for the treatment of disease.

4. Computerized Axial Tomographic Scanning Services. Services associated with a diagnostic imaging device which uses a computer to analyze the differential strength of X-ray beams passed through body tissues in order to locate and identify abnormalities.

5. End Stage Renal Disease Services: Services associated with the stage of renal impairment which is almost always irreversible and permanent, and requires dialysis or kidney transplantation to maintain life. ESRD services include, but are not limited to, the following, which are provided in health care facilities:
a Renal dialysis - a process by which waste products and excess fluid are removed from an ESRD patient's body by osmosis from one fluid compartment to another hemodialysis and peritoneal dialysis);

b Renal transplantation - a process by which a kidney is excised from a live or cadaveric donor and such kidney is implanted in an ESRD patient and supportive care is furnished to the living donor and to the recipient following implantation.

6. Neonatal Special Care Nurseries. Specialized nursing units which concentrate on seriously ill neonates needing constant observation and specialized support equipment and care. Neonatal special care units usually take on a regionalized configuration with three specific levels of care:
a Level I. A Level I unit primarily provides services for uncomplicated maternity and newborn patients with critical consideration given to the earliest possible detection of the "high-risk" maternity and newborn patient and the capability to provide emergency obstetric and newborn care;

b Level II. A Level II unit provides a full range of maternal and neonatal services for uncomplicated patients and for the majority of complicated obstetrical problems and certain neonatal illnesses. Level II units are those which are equipped either to provide for in-hours patients only (nonreferral) or for both in-house and referral patients (referral).

c Level III. A Level III unit provides care for normal patients but especially for all the serious types of maternal-fetal and neonatal illnesses and abnormalities. Level III units provide continuing education to improve the overall quality of care and generate, develop, and evaluate new concepts and techniques in prenatal and perinatal pare. A Level III unit may be actively engaged in clinical and basic research related to perinatal health. Pediatric Care Services. Inpatient and outpatient services provided in health care facilities to care for medical/and or surgical patients less than 14 years old, excluding neonatal special care nurseries.

8. Obstetrical Care Services. Inpatient and outpatient services provided in health care facilities to maternity and newborn patients. Also see "Neonatal Special Care Nurseries" in this section for definition of level of care designations for obstetric services.

9. Intermediate Care Facilities. Facilities licensed or certified by the Department of Human Services as intermediate care facilities to provide medically and socially oriented nursing care necessitating licensed nursing supervision and/or services and/ or medical therapy of a moderately complex yet specific nature on a long-term basis. This care would meet the current health needs and promote The maximum physical and psychosocial well-being of patients receiving such care.

10. Skilled Nursing Facilities. Facilities licensed or certified by the Department of Human Services as skilled nursing facilities to provide skilled nursing care -- a service necessitating skilled nursing techniques and/or medical therapy of a complex and/or intensive degree on a long-term basis. The care would meet the current health needs and promote the maximum physical and psychosocial well-being of patients receiving such care. on a 24-hour basis. Licensed nursing care and supervision is required.

11. Home Health Care Services. A health care service provided by an agency in a patient's residence for pay or other consideration according to a written and signed plan of treatment prescribed by a physician. The health care services provided in a patient's residence include nursing care, physical therapy, occupational therapy, speech therapy, medical social service, home health aide, furnishing medical supplies, and nutritional counseling.

12. Psychiatric Care Services. A service provided by hospitals or other health care facilities which deals with the study, treatment, and prevention of mental illness.

13. Chemical Dependency Service. An acute inpatient or outpatient service which specializes in the treatment of patients with substance addiction.

14. ICU/CCU Service. A specialized nursing service or unit which concentrates within one area of a hospital seriously ill patients needing constant nursing care and observation. The service may limit itself to the care of just cardiac patients, or may serve a mixed population.

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