Subsection 144-101-II-65.10 - REIMBURSEMENTA. The amount of payment for services rendered by a provider shall be the lowest of the following: 1. The amount listed in Chapter III;2. The lowest amount allowed by the Medicare Part B carrier; or3. The provider's usual and customary charge.B. The daily rate of delivering crisis services to a member by an agency in the member's home on a quarter hour basis must not exceed the per diem rate of crisis support services delivered by an agency to a member outside the home. Please see Section 65.07, Limitations, for provider eligibility for reimbursement.C. In accordance with Chapter I, Section 1, of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from any other resources that are available for payment of the rendered service prior to billing the MaineCare Program. MaineCare is not liable for payment of services when denied or paid at a rate reduced by a liable third party payer, including Medicare, because the services were not authorized, or a non-participating provider provided services that were coverable under the plan.65.10-1 Rate Determination for ProvidersDHHS will contract with providers that meet all DHHS and MaineCare guidelines and contracting requirements to provide services under this Section and are currently in good standing with DHHS.
DHHS will use the following as factors affecting the determination of the rates:
- Reasonable, necessary and comparable costs;
- Productivity levels;
- Cost caps; and
- Service design and delivery.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-65, subsec. 144-101-II-65.10