Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 510 - REGULATIONS GOVERNING THE RURAL MEDICAL ACCESS PROGRAM
Section 144-510-V - PHYSICIAN QUALIFICATIONS FOR PREMIUM ASSISTANCE

Universal Citation: 10 ME Code Rules ยง 144-510-V

Current through 2024-38, September 18, 2024

A qualified physician may be found eligible to receive professional liability premium assistance only if he or she:

A. Is licensed to practice medicine in the State of Maine and subscribes to appropriate obstetrical malpractice insurance coverage.

B. Files an application for premium assistance with the Department's Office of Planning. Research and Development. Separate applications will be made available for each of the two eligibility classes, i.e., the automatic eligibility areas (MUAs and HPSAs) and the Commissioner designated eligibility areas.

C. Provides in the written application the total number of prenatal care patients and deliveries as well as the total number of prenatal care patients and deliveries that are covered through Medicaid. Physician eligibility will be determined as follows:

1. For the physician to qualify for HPSA/MUA area eligibility, the physician's Medicaid eligible patients must represent at least 10% of the physician's total prenatal/obstetrical care practice during the preceding 6 months. In those situations where a physician does not limit or refuse treatment to Medicaid recipients but the percentage of Medicaid patients is still below 10% of his/her total prenatal/obstetrical care caseload. a waiver of this stipulation may be granted by the Department.

2. For the physician to qualify for the Commissioner designated physician practice area eligibility a combination of the number of Medicaid patients and patients who reside in the adjacent underserved areas. must equal 50% of the physician's total practice.

D. Provides complete obstetrical care for patients, including prenatal care and delivery, except that a physician in an underserved area without a facility for obstetrical delivery may qualify if the physician provides all services except delivery services but has a referral agreement for delivery with a licensed physician who accepts and serves Medicaid patients.

E. For at least 50% of his or her work time provides patient services in areas of the State that are determined to be underserved areas for obstetrical and prenatal services under II. above; or has provided written documentation that fully details and confirms that at least 50% of the practice patients are either Medicaid recipients or reside in the adjacent MUA/HPSA.

F. Has provided obstetrical and/or prenatal care services in a designated area. including to Medicaid patients, for at least the previous 6-month period, except in the case of new physicians wherein the premium assistance will be granted prospectively when funding is available.

G. Provides in the application, the name of the insuring company. the policy number and the entity who pays the premium.

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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