C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-15, subsec. 144-101-II-15.02

Current through 2024-51, December 18, 2024
Subsection 144-101-II-15.02 - DEFINITIONS
15.02-1Chiropractic Services are those services provided to a member by a licensed chiropractor.
15.02-2Chiropractor is an individual who both is licensed by the state or province in which he/she provides chiropractic services and meets uniform minimum standards promulgated by the Secretary of Health and Human Services under 42 U.S.C. § 1395x(r) and 42 C.F.R. 440.60.
15.02-3Rehabilitation Potential is a documented expectation by the member's primary care provider or prescribing provider (Medical Doctor (MD), Doctor of Osteopathic (DO), Physician Assistant (PA), or Advanced Practice Registered Nurse (APRN)), who is licensed and acting within the scope of his or her license, indicating that the member's condition will improve significantly in a reasonable, predictable period of time as a result of the prescribed treatment plan.
15.02-4Prior Authorization is the process of obtaining prior approval from the Department as to the medical necessity and eligibility for certain MaineCare services before they are delivered, as set forth herein and in Chapter I, Section 1 of the MaineCare Benefits Manual (MBM).

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-15, subsec. 144-101-II-15.02