C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-71, subsec. 144-101-II-71.03

Current through 2024-51, December 18, 2024

Subsection 144-101-II-71.03 - MEMBER ELIGIBILITY

71.03-1General Eligibility

Individuals must meet the eligibility and residency requirements set forth in the MaineCare Eligibility Manual, 10-144 CMR Ch. 332. Some members may have restrictions on the type and amount of services they are eligible to receive. MaineCare Providers must verify an individual's eligibility for MaineCare prior to providing services, pursuant to Chapter I, Section 1, of the MaineCare Benefits Manual (MBM), 10-144 CMR Ch. 101.

71.03-2Program Eligibility

Providers may receive reimbursement for members participating in the National DPP LCP who meet the following criteria:

A. The member meets the participant eligibility requirements in the current DPRP Standards (see the Appendix); and

B. The member received a referral to enroll in the National DPP LCP from a physician or other qualified provider acting within his or her scope of practice.

Providers shall retain qualifying eligibility criteria and the referral in the member's record.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-71, subsec. 144-101-II-71.03