Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 509 - RULES FOR DESIGNATING AREAS, POPULATIONS OR HOSPITALS AS UNDERSERVED BY SPECIALTY PHYSICIANS
Section 144-509-IV - CRITERIA FOR UNDERSERVED SPECIALTY PRACTICE DETERMINATION
Universal Citation: 10 ME Code Rules ยง 144-509-IV
Current through 2024-38, September 18, 2024
1. The Commissioner of Human Services will designate a PCAA as underserved for a specific specialty physician if it meets the following criteria:
A. Contiguous area
specialty physician resources are considered overutilized if the contiguous
area resources there are not sufficient to meet the need of the area being
considered for designation as underserved. The contiguous area must have at
least the excess capacity as required to serve the area under review.
B. Contiguous area specialty physician
resources are considered excessively distant if the specialist physician is
located more than 30 miles by secondary roads, 35 miles by primary roads, or 40
miles by interstate/turnpike highways from the center of the service area being
considered for designation.
2. The Commissioner of Human Services will consider special designation on a case-by-case basis, at the request of providers or community representatives, based on any of the following circumstances.
A. The Commissioner of Human
Services may designate an underserved specialty physician area as a less than
full-time site, prorated based on unserved population ratio due to its small
population.
B. The Commissioner of
Human Services may designate more than one service area as one practice site if
areas, when considered alone, do not have sufficient population base to support
a specialist physician practice.
C.
The Commissioner of Human Services may designate an area-as underserved
geographic area which meets at least one of the following criteria:
1 More than 20% of the population (or of all
households) have incomes below the poverty level; or the Medicaid population
exceeds the most recently calculated state Medicaid rates, or
2 Documentation is provided that none of the
area's specialists are accepting new Medicaid patients.
D. The Commissioner of Human Services may
designate a specific specialty physician practice as eligible for loan
forgiveness of the applicant physician's State obligation if at least 50% of
the patients are covered by Medicaid or are indigent without a means of paying
for care.
3. The Commissioner of Human Services will designate a hospital as underserved for a specialty if all the following criteria are satisfied:
A. The Hospital provides documentation that
demonstrated that the Hospital Board of Directors/Trustees has participated in
and formally approved a long range plan for securing the appropriate number of
medical staff designed to resolve specialty physician shortages.
B. The hospital provides documentation that
attempts over a minimum of one year period to secure the needed specialists
have been unsuccessful, including but not limited to advertising in and out of
state, communications with specialists who inquire about the position,
interview notations.
C. The
hospital provides assurances that adequate back-up services needed by that
specialty, as determined by nationally approved practice perimeters, are
readily available.
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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