For income eligible neonates birth up to thirty (30) days of age the following supplemental services are available retroactive to the date of birth if the application and medical center referral and verification is received within the first month of birth:
initial emergency transport to an in-state Level II or Level III facility as classified by the Maine State Health Department and return to a lower level in-state facility as medically indicated; transport to an out-of state tertiary care center is available only on referral by Eastern Maine Medical Center, Central Maine Medical Center, or Maine Medical Center; pediatric subspecialty diagnostic evaluations and consultations at an in-state Level II or Level III facility; and/or surgeon costs only for emergency surgery.NON-COVERED NEONATAL SERVICES: Routine care of the newborn, or neonatal intensive care.
10- 144 C.M.R. ch. 272, § VII-G