C.M.R. 10, 144, ch. 101, ch. X, § 144-101-X-1, subsec. 144-101-X-1.05

Current through 2024-51, December 18, 2024

Subsection 144-101-X-1.05 - COVERED SERVICES

The following MaineCare categories of services and respective policies of the MaineCare Benefits Manual(MBM) are included in the limited benefit for enrollees under this Section::

General Category of Service	Services
Inpatient	MBM Chapter II, Section 45, Hospital Services
Psychiatric Facility	MBM Chapter II, Section 46, Psychiatric Hospital Services
Outpatient	MBM Chapter II, Section 45, Hospital Services
EPSDT Examinations	MBM Chapter II, Section 94, Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT); Section 90, Physician Services Examinations: Physician Services)
Medications	MBM Chapter II, Section 80, Pharmacy Services
Community Support Services	MBM Chapter II, Section 17, Community Support Services; The Department shall seek and anticipates receiving approval for this section from the Centers for Medicare and Medicaid Services (CMS). Pending approval, covered services will include Section 92, Behavioral Health Home Services
Lab & X-ray	MBM Chapter II, Section 55, Laboratory Services; Section 101, Medical Imaging Services
Transportation	MBM Chapter II, Section 113, Non-Emergency Transportation Services; benefit will only pay for transportation to and from MaineCare covered services; Section 5, Ambulance Services
Ambulatory Care	MBM Chapter II, Section 3, Ambulatory Care Clinic Services; The Department shall seek and anticipates receiving approval for this section from the Centers for Medicare and Medicaid Services (CMS). Pending approval, covered services will include Section 4, Ambulatory Surgical Center Services
Case Management	MBM Chapter II, Section 13.03, Targeted Case Management Services
Family Planning	MBM Chapter II, Section 30, Family Planning Agency Services
Behavioral Health	MBM Chapter II, Section 65, Behavioral Health Services (including Psychological Services); Section 92, Behavioral Health Home Services
Medicare Crossover-A	MBM Chapter II, Section 45, Hospital Services
STI/STD Testing and Treatment	MBM Chapter II, Section 30, Family Planning Services; Section 90, Physician Services
Medicare Crossover-B	MBM Chapter II, Section 90, Physician Services; Section 31, Federally Qualified Health Center Services; Section 103, Rural Health Clinic Services
Physician, Physician Assistant, Advanced Practice Registered Nurse, Certified Nurse Practitioner, Ophthalmologist	MBM Chapter II, Section 90, Physician Services; Section 14, Advanced Practice Registered Nursing Services; The Department shall seek and anticipates receiving approval for this section from the Centers for Medicare and Medicaid Services (CMS). Pending approval, covered services will include Section 91, Health Home Services; Section 31, Federally Qualified Health Center Services; Section 103, Rural Health Clinic Services, and Section 9, I ndian Health Services
Services for Children with Intellectual Disability or Autism	MBM Chapter II, Section 28, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations
Developmental and Behavioral Clinical Services	MBM Chapter II, Section 23, Developmental and Behavioral Clinic Services
Substance Abuse Treatment	MBM Chapter II, Section 65, Behavioral Health Services