C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-30, subsec. 144-101-II-30.07

Current through 2024-51, December 18, 2024

Subsection 144-101-II-30.07 - REIMBURSEMENT

A. The maximum amount of payment for service rendered shall be the lowest of the following:

1. The provider's usual and customary charge.

2. The amount listed in Chapter III, Section 30, and the Department's rate setting website: www.maine.gov/dhhs/audit/rate-setting/index.shtml.

3. The lowest amount allowed by Medicare Part B when such service is covered.

B. Family planning agencies are reimbursed at the same fee for service rates as other providers of these services, including Section 90, "Physician Services", where applicable.

C. Family planning agency service providers, when furnishing covered services, shall be reimbursed for interpreter services provided to deaf/hard of hearing MaineCare members when these services are necessary to communicate effectively with the member regarding health-care needs. Refer to the MaineCare Benefits Manual Chapter I for more information on interpreter services.

D. In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from any other sources that are available for payment of a rendered service prior to billing the MaineCare Program.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-30, subsec. 144-101-II-30.07