Subsection 144-101-IV-1.05 - EMERGENCY HEALTH CARE SERVICES AND NON-PRIMARY CARE PROVIDERSNon-primary care providers shall be reimbursed for health care services only in the following circumstances:
A. When the need to stabilize an emergency medical condition (as defined in Section 1.02-4.B. & C., Chapter I of the MaineCare Benefits Manual, also refer to Chapter IV, Section 1.03-5) exists. Reimbursement is subject to the provider's later written or verbal verification of that need when requested by the Program Integrity Unit; B. When the member has been referred by the primary care provider; andC. When the member has received services without a referral from providers whose category of service is not covered by the restriction plan, i.e., x-ray, laboratory, and optometrists. C.M.R. 10, 144, ch. 101, ch. IV, § 144-101-IV-1, subsec. 144-101-IV-1.05