Subsection 144-101-II-60.01 - DEFINITIONS60.01-1Activities of Daily Living (ADL) are those activities related to personal care including but not limited to: showering, bowel/bladder management, eating, functional mobility, personal device care (hearing aids, etc.), personal hygiene, and toileting.60.01-2Adjusted Acquisition Cost is the lowest price paid to a supplier by an eligible provider for Durable Medical Equipment or medical/surgical supplies after adjustments for quantity discounts, any prompt payment discounts and excluding all associated costs, including but not limited to, shipping, freight, handling, and insurance costs. Wheelchair providers need not adjust the price paid to a supplier based on any prompt payment discount.60.01-3Department is the Maine Department of Health and Human Services.60.01-4Durable Medical Equipment (DME) is:A. Equipment that can withstand repeated use;B. Primarily used to serve a medical purpose and is medically necessary and reasonable for the treatment of the member's disability, illness, or injury or to improve an altered body function. Examples of items that are not primarily used for medical purposes include air conditioners, pools, exercise equipment, and equipment primarily used for the convenience of a caregiver;C. Not generally useful to a person in the absence of disability, illness, or injury; andD. Medical supplies, equipment, and appliances suitable for use in any setting in which normal life activities take place and is in safe and reasonably good condition and suitable for its intended use. All four (4) of the above criteria must be met for coverage under this Section. Specific definitions and criteria are located on the MaineCare Health PAS Online Portal.
Home/Environmental modifications do not meet the definition of medical supplies or DME and are not covered under this Section.
60.01-5Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) is a facility that meets State licensing and Federal certification requirements for ICFs-IID.60.01-6Medical Supplies are those Medical Supplies that are primarily needed to relieve or control a medical condition. Examples of supplies not primarily needed to relieve or control a medical condition include, but are not limited to, room and underarm deodorants.60.01-7Nursing Facility (NF) means a Skilled Nursing Facility (SNF) in the Medicare program or a Nursing Facility (NF) in the MaineCare program which meets State licensing and Federal certification requirements for nursing facilities and has a valid agreement with the Department of Health and Human Services.60.01-8Prior Authorization (PA) is the process of obtaining prior approval as to the medical necessity and eligibility for a service.60.01-9Power Mobility Device (PMD) includes both integral frame and modular construction type Power Wheelchairs (PWCs) and power operated vehicles (POVs).60.01-10Power Operated Vehicle (POV) is a chair-like battery powered mobility device for people with difficulty walking due to illness or disability, with integrated seating system, tiller steering, and three or four-wheel non-highway construction.60.01-11Power Wheelchair (PWC) is a chair-like battery powered mobility device for people with difficulty walking due to illness or disability, with integrated or modular seating system, electronic steering, and four or more wheel non-highway construction.60.01-12Qualified Provider is a provider who is qualified by education, training, and licensure/regulation to perform services within his or her scope of practice. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-60, subsec. 144-101-II-60.01