C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-7, subsec. 144-101-II-7.04

Current through 2024-51, December 18, 2024

Subsection 144-101-II-7.04 - COVERED SERVICES

For members who are establishing Medicare eligibility, MaineCare will cover renal dialysis services for the first three months of dialysis pending the establishment of Medicare eligibility. Medicare becomes the primary reimbursement source for all individuals who meet Medicare eligibility criteria. Dialysis providers must assist MaineCare members in applying for and pursuing final Medicare eligibility determinations. For those MaineCare members who are not Medicare eligible, MaineCare will continue to be the payer of last resort for dialysis services.

A.Renal Dialysis. Medically necessary renal dialysis services for eligible MaineCare members are covered under this section. Renal dialysis includes services, supplies, and routine laboratory tests as specified in Section 7.05.

B.Prescribed Drugs. MaineCare reimburses dialysis clinics for prescribed drugs as specified in Section 7.05.

C.Training for Home Dialysis. MaineCare reimburses for home dialysis training, including self-dialysis (hemodialysis, nocturnal intermittent peritoneal disease, and continuous cycling peritoneal dialysis) and continuous ambulatory peritoneal dialysis training only where the MaineCare member attends such training at the clinic site.

To facilitate coordination of benefits, the Department will follow Medicare coverage policies and claims submission requirements, as appropriate.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-7, subsec. 144-101-II-7.04