№ files_lp_3_process_7_041787
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This document outlines the services and allowances for Occupational Therapy under MaineCare, including various therapy procedures, modalities, and their corresponding rates.
Year:
2012
Region / City:
Maine
Topic:
Occupational Therapy Services
Document Type:
Policy document
Organization:
MaineCare
Author:
MaineCare
Target Audience:
Healthcare providers and occupational therapists
Period of Validity:
Ongoing
Approval Date:
06/29/12
Modification Date:
None
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2025
Region / City:
Maine
Theme:
Healthcare, Medicaid
Document Type:
Manual
Institution:
Department of Health and Human Services, Office for Family Independence
Author:
State of Maine
Target Audience:
General public, healthcare professionals, individuals seeking MaineCare benefits
Period of Validity:
Until April 29, 2025
Approval Date:
April 29, 2025
Date of Changes:
Not specified
Year:
2025
Region / City:
Maine
Topic:
Healthcare Eligibility
Document Type:
Manual
Organization:
Department of Health and Human Services, Office for Family Independence
Author:
Unknown
Target Audience:
State officials, healthcare providers, and applicants for MaineCare
Period of Validity:
Effective April 29, 2025
Approval Date:
Not specified
Date of Last Update:
April 29, 2025
Contextual Description:
A policy manual providing eligibility criteria and administrative processes for MaineCare, including coverage groups, benefits, and eligibility verification methods.
Year:
2023
Region / City:
Maine
Subject:
Home Health Care Services
Document Type:
Regulations
Agency:
MaineCare
Author:
Maine Department of Health and Human Services
Target Audience:
Healthcare providers, home health agencies, certified home health aides, and healthcare professionals involved in home care services
Effective Period:
Ongoing
Approval Date:
N/A
Date of Amendments:
N/A
Year:
N/A
Region / City:
Maine
Topic:
Medicaid Administration
Document Type:
Policy Manual
Organization / Institution:
Maine Department of Health and Human Services
Author:
N/A
Target Audience:
Health Providers, MaineCare Participants
Validity Period:
N/A
Approval Date:
N/A
Modification Date:
N/A
Note:
Year
Subject:
Speech and Hearing Services
Document Type:
Policy
Organization:
MaineCare
Target Audience:
Healthcare Providers, Speech and Hearing Professionals
Context Description:
Policy detailing specific billing codes and modifiers for speech and hearing services covered under MaineCare, including professional rates for various diagnostic and treatment procedures.
Jurisdiction:
State of Maine, United States
Program:
MaineCare
Governing Law:
Title XVIII, XIX, and XXI of the Social Security Act; 42 U.S.C.A. §§1395 et seq.; 42 U.S.C.A. §§1396 et seq.; 42 U.S.C. §1397; 22 M.R.S. §§10, 12, 42(1), 3173 et seq.; 22 M.R.S. §1901 et seq.; 22 M.R.S. §3174-T
Administering Authority:
Maine Department of Health and Human Services
Federal Oversight:
Centers for Medicare and Medicaid Services (CMS)
Document Type:
Benefits manual / administrative regulations
Subject:
Administration, provider participation, member eligibility, covered services, reimbursement, compliance, appeals, and program integrity
Related Programs:
Medicare; Medicaid; State Children’s Health Insurance Program (CHIP); Cub Care Program
Responsible Units:
Office for Family Independence; Program Integrity Unit; Division of Audit; Office of MaineCare Services
Scope:
Statewide administration of MaineCare benefits and services
Year:
2023
Region / City:
Maine
Theme:
Health care services
Document type:
Policy
Agency:
MaineCare
Author:
Maine Department of Health and Human Services
Target audience:
MaineCare providers and beneficiaries
Period of validity:
Ongoing
Approval date:
N/A
Amendment date:
N/A
Year:
2022
Region / City:
Maine
Theme:
Healthcare Services for Children and Adolescents
Document Type:
Guidelines
Organization:
MaineCare
Author:
Maine Department of Health and Human Services
Target Audience:
Healthcare Providers, MaineCare Members, and Their Caregivers
Effective Period:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2015
Region / City:
Maine
Topic:
Non-Emergency Transportation
Document Type:
Policy and Procedure
Organization / Institution:
Maine Department of Health and Human Services
Author:
MaineCare Services
Target Audience:
MaineCare Members, Transportation Providers, Brokers
Effective Period:
From 4/5/2015
Approval Date:
4/5/2015
Date of Last Update:
4/5/2015
Effective Date:
11/18/14
Program:
MaineCare
Jurisdiction:
Maine
Country:
United States
Issuing Authority:
Department of Health and Human Services
Regulatory References:
45 C.F.R. §162.1000; 45 C.F.R. §1011; 42 C.F.R. §447.205
Related Agency:
Centers for Medicare and Medicaid Services (CMS)
Document Type:
Reimbursement rate schedule and billing code list
Subject:
Family planning services and related medical procedures
Code System:
Healthcare Common Procedure Coding System (HCPCS)
Update Frequency:
Approximately quarterly updates issued by CMS
Provider Requirements:
Use of FP modifier for applicable services; CLIA-waiver certificate required for certain laboratory codes
Reimbursement Basis:
Fee-for-service rates
State Plan Requirement:
Payment subject to approval of a state plan amendment by CMS
Publication Method:
Notices of reimbursement methodology change and revised billing instructions
Web Reference:
www.maine.gov/dhhs/audit/rate-setting/index.shtml
Year:
2026
Region:
Maine, USA
Topic:
Healthcare Payment and Delivery Model
Document Type:
Policy and Program Manual
Organization:
Maine Department of Health and Human Services
Author:
MaineCare Program Administration
Target Audience:
Primary Care Providers and MaineCare Members
Participation:
Voluntary for both providers and members
Payment Model:
Population-Based Payments with Performance-Based Adjustments
Implementation Period:
Ongoing
Certification Reference:
CEHRT under 42 CFR §414.1305
Legal Authority:
Social Security Act Section 1905(t)(1)
Scope:
Primary care, behavioral health integration, care plans, and community health workers
Operational Structure:
Accountable Communities, Joint Care Management, Community Care Teams
Risk Assessment:
Member attribution, risk scores, and performance measures
Reimbursement Mechanism:
Tiered PBPs and quarterly PBAs
Year:
1998
Region / City:
United States
Topic:
Health Insurance, Legal Rights
Document Type:
Legal Notice
Organ / Institution:
Federal Government
Author:
Not specified
Target Audience:
Individuals with health coverage
Period of Validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2023
Region / City:
Victoria, Australia
Theme:
Gender equality in sports media, women’s sports coverage
Document Type:
Research study
Organization / Institution:
Victorian Government
Author:
N/A
Target Audience:
General public, media professionals, sports enthusiasts
Period of validity:
2023
Approval Date:
N/A
Date of Changes:
N/A
Note:
Year
Region / City:
Ottawa
Subject:
Health Insurance Coverage
Document Type:
Contractual Agreement
Organ / Institution:
Embassy of Italy
Target Audience:
Economic Operators
Period of Validity:
Five years
Note:
Year
Topic:
Medical Treatment Request
Document Type:
Letter
Author:
[Insert Healthcare Provider’s Name]
Target Audience:
Insurance Company
Coverage period:
01/01/2025–12/31/2025
Plan name:
Plan Option 1
Plan type:
PPO
Coverage level:
Family
Insurance company:
Insurance Company 1
Document type:
Summary of Benefits and Coverage
Overall deductible:
$500 individual / $1,000 family
Out-of-pocket limit:
$2,500 individual / $5,000 family (network); $4,000 individual / $8,000 family (out-of-network)
Referral requirement:
Required for specialist visits
Prescription drug coverage:
Included with tiered cost sharing
Preventive services coverage:
Covered before deductible
Note:
Year
Theme:
Adoption Assistance
Document Type:
Annual Assurance Form
Agency / Organization:
Ohio Department of Children and Youth
Target Audience:
Adoptive Parents, Eligibility Determiners
Note:
Year
Type of Document:
Insurance Application
Organization / Institution:
Chubb
Intended Audience:
Prospective insured entities
Coverage Types:
Professional Liability, General Liability, Managed Care Errors & Omissions, Employee Benefits Liability, Excess Liability
Required Information:
Applicant details, retroactive dates, subsidiaries, additional insureds, accreditation status, coverage specifications, loss experience, exposures
Year:
2026
Region / City:
Not specified
Theme:
Health Insurance Coverage
Document Type:
Summary of Benefits
Organ / Institution:
Not specified
Author:
Not specified
Target Audience:
Individuals seeking health insurance information
Effective Period:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2026
Type of Document:
Health insurance summary
Organization:
UMR
Target Audience:
Health plan members
Coverage Details:
In-network and out-of-network services
Deductible:
$1,000 individual / $2,000 family in-network, $2,000 individual / $4,000 family out-of-network
Out-of-Pocket Limit:
$2,500 individual / $5,000 family in-network, $5,000 individual / $10,000 family out-of-network
Copayment and Coinsurance:
Specified per service type
Services Covered:
Preventive care, primary and specialist care, diagnostic tests, imaging, prescription drugs, outpatient and inpatient care, mental health, maternity, home health
Provider Network:
Yes
Referral Requirement:
No for specialists
Glossary Reference:
www.umr.com
Note:
or 1-800-207-3172
Period of Validity:
Annual coverage period