Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-55 - Laboratory Services › Subsection 144-101-II-55.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
55.01-1
Laboratory Services
Laboratory Services ordered by or under the direction of
						a physician or a licensed practitioner of the healing arts within the scope of
						his or her practice as defined by state law; and provided by a laboratory that
						is in compliance with the pertinent sections of 22 M.R.S.A. symbol 167 if "Kino
						MT" is 112011
et seq
. (
Maine Medical Laboratory
						Act
) and the rules and regulations promulgated thereunder, meets the
						requirements for participation in Medicare and is in compliance with the rules
						implementing the
Clinical Laboratory Improvement Amendments of
						1988
(CLIA 88).
55.01-2
Medical/Clinical
					 Laboratory
Any institution, building or place which provides
						through its ownership or operation an organization which employs methods and
						instruments for the examination of blood, tissues, secretions, and excretions
						of the human body or any function of the human body in order to diagnose
						disease, follow the course of disease, aid in the treatment of such disease, or
						detect drugs or toxic substances or which produces information used as a basis
						for health advice or which purports to offer such examinations unless otherwise
						provided by law.
55.01-3
Physician's Office Laboratory
A laboratory operated by a physician or group practice
						exclusively to provide Laboratory Services for its own patients that is in
						compliance with the pertinent Sections of 22 M.R.S.A. symbol 167 if "Kino MT"
						is 112011
et seq
. and the rules and regulations promulgated
						thereunder and meets the requirements for participation in Medicare and is in
						compliance with the rules implementing the
Clinical Laboratory
						Improvement Amendments of 1988
(CLIA 88).
55.01-4
Practitioner of the Healing
					 Arts
Physicians and all others registered or licensed in the
						healing arts, including, but not limited to, nurse practitioners, podiatrists,
						optometrists, chiropractors, physical therapists, occupational therapists,
						speech therapists, dentists, psychologists and physicians'
						assistants.
55.01-5
Group Practice Laboratory
A laboratory established for the mutual use of physician
						or group practice owners, is considered an Independent Clinical Laboratory (See
						55.01-3 and 55.01-5).
55.01-6
Independent Clinical
					 Laboratories
An Independent Clinical Laboratory is one which is not
						under direct jurisdiction of a hospital or the patient's attending physician.
						For reimbursement under Title XIX, the independent laboratory must be certified
						as an Independent Clinical Laboratory in accordance with the Medicare
						conditions of participation and must be licensed under the provisions of 22
						M.R.S.A. symbol 167 if "Kino MT" is 112011
et seq
. and the
						rules and regulations promulgated thereunder and be in compliance with the
						rules implementing the
Clinical Laboratory Improvement Amendments of
						1988
(CLIA 88).
55.01-7
Prior Authorization
Prior Authorization is the process of obtaining prior
						approval from the Department as to the medical necessity and eligibility for
						certain MaineCare services before they are delivered, as set forth herein and
						in Chapter I, Section 1 of the
MaineCare Benefits Manual
(MBM).