C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-01, subsec. 144-101-VI-01.06
Members who experience an emergency medical condition may access emergency services without first contacting their PCP for a referral.
Post-stabilization services will be provided to members and will be payable by MaineCare if (i) the services are pre-approved by the PCP (or his/her covering provider) or (ii) the services are not pre-approved because the PCP has not responded within one (1) hour after receiving the provider's request, or cannot be contacted for approval. In this case, the treating physician decides whether or not to provide post-stabilization services. If post-stabilization services are not pre-approved, MaineCare's financial responsibility for post-stabilization services ends when the enrollee is discharged. (Post-stabilization services do not include those exempt services, as described in Section 1.05.)
The PCP must ensure that his/her covering provider(s) is authorized to provide necessary referrals in order to comply with post-stabilization provisions described above.
As detailed in MBM Chapter 1, MaineCare will not cover any services after stabilization of the emergency condition for non citizens. Examples of services that are not considered an emergency medical condition include, but are not limited to: dialysis, organ transplants, school based services, personal care services, waiver services, nursing facility services and hospice services.
C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-01, subsec. 144-101-VI-01.06