C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-45, subsec. 144-101-II-45.05
Each eligible member may receive as many pints of whole blood and packed red blood cells as are medically necessary.
In the case of a MaineCare member who is also receiving Title XVIII benefits, MaineCare will pay for the first three pints of blood, not covered under Title XVIII.
Whole blood (provided the hospital cannot obtain a replacement donation) and packed red blood cells will be reimbursable only for each pint administered.
Reimbursement will not be made on the basis of replacing two pints of blood for each pint received by the member regardless of whether the blood (either fully or partially) is provided from a blood bank or from a donor.
MaineCare reimburses for services provided to newborn infants of MaineCare mothers during the time the mother is hospitalized. MaineCare will pay for services to the newborn after the mother is discharged, if these services are certified by the physician as being medically necessary and the infant is MaineCare eligible.
MaineCare will only reimburse hospitals for these services if documentation meets the requirements of Chapter II, Section 90, "Physician Services".
Dental services provided in a hospital setting are only covered for emergency care or medically necessary to be done in a hospital setting.
MaineCare will reimburse for private rooms for patients with infectious diseases when medically necessary to meet the patient's medical needs or to prevent the spread of disease.
The designee of the committee charged with infection control must document the medical necessity in the patient's medical record. The designee must formally inform the committee of his or her decisions regarding assigning private rooms to patients with infectious disease. The committee must record the designee's actions in its minutes.
Unless prior authorization (PA) has been granted by the Department, DHHS will not reimburse hospitals for any costs associated with any restricted physician services performed in the hospital, which require PA pursuant to Chapter II, Section 90 ("Physician Services") of this Manual. Additionally, all other Section 90 limitations and restrictions apply to Section 90 services provided in hospitals.
Please refer to Chapter II, Section 90, Appendix A, "Physician Services", of this Manual for specific information related to MaineCare coverage of and criteria for transplant procedures.
Effective April 1, 2013, all hospitals must inform patients who are in days awaiting NF placement, in writing, of their right to twenty (20) overnight leaves of absence per state fiscal year (July 1st through June 30th).
MaineCare will reimburse a hospital to reserve a bed for a member on an overnight leave of absence if the following conditions are met:
MaineCare only reimburses for observation or testing when ordered by a physician. Outpatient observation must not exceed forty-eight (48) hours.
Physical, occupational and speech therapy for members age twenty-one (21) and over must be provided in accordance with Section 68, "Occupational Therapy Services"; Section 85, "Physical Therapy Services"; and Section 109, "Speech and Hearing Services", respectively, including any limitations or requirements for rehabilitation detailed in those Sections of the MBM.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-45, subsec. 144-101-II-45.05