C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-113, subsec. 144-101-II-113.05

Current through 2024-44, October 30, 2024
Subsection 144-101-II-113.05 - NON-COVERED SERVICES

Non-Emergency Transportation (NET) services do not include:

A. Ambulance Services: Ambulance Services are covered in the MaineCare Benefits Manual, Section 5 (Ambulance Services);
B. Transportation for individuals residing in Nursing Facilities and for individuals residing in Intermediate Care Facilities for individuals with Intellectual Disabilities or Pervasive Developmental Disorders (ICF-IIDs) unless there is a written request from the facility to the Department that it is unable to supply the transportation for good cause, the transportation is for medically necessary medical service, and that written request has been prior approved by the Department;
C. Transportation to visit a sick infant or child or critically ill/injured spouse, except as allowed above for visits by a parent, foster parent, or guardian to his or her children admitted to a hospital under an inpatient status. Transportation to visit an inpatient adult MaineCare member is not covered.
D. Transportation for individuals ineligible for NET services. Brokers must verify Member eligibility prior to authorizing transports.
E. Transportation to return a Member to Maine from another state, unless the Member was in another state for the purpose of obtaining MaineCare approved medical services.
F. Transportation for Members when those same trips are available at no cost to the general public or when the general public is being transported in the same vehicle at no cost. Brokers may waive this requirement for Members for whom free transportation is medically inappropriate.
G. Transportation where no actual Member transport occurred, even if the NET services may have been authorized by the Broker, such as a no-show or a cancellation.
H. Transportation for Members to see providers not enrolled in MaineCare.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-113, subsec. 144-101-II-113.05