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-9 - INDIAN HEALTH SERVICES › Subsection 144-101-II-9.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
09.01-1
Contract Health Services
					 (CHS)
means health services provided at the expense of the Indian Health
					 Service from public or private medical or hospital facilities other than those
					 of the Indian Health Service. [Title
					 42
					 CFR Section 136.21 ]
09.01-2
Covered Services
are
					 those services described in Section 9.04 for which payment may be made under
					 Title XIX of the Social Security Act.
09.01-3
Direct Effect
is any
					 effect caused by a change or update in policy on a service tribes are
					 reimbursed for through MaineCare Services. (Some examples of changes that would
					 constitute direct effect are: changes "that are more restrictive for
					 eligibility determinations, changes that reduce payment rates or changes in
					 payment methodologies to I/T/U providers or for services reimbursed to I/T/U
					 providers, reductions in covered services, changes in consultation policies,
					 and proposals for demonstrations or waivers that may impact Indians or I/T/U
					 providers.") (SMDL 10-001, January 22, 2010)
09.01-4
Indian Health Center
is
					 an outpatient health program or facility operated by a tribe or tribal
					 organization under the Indian Self-Determination Act or by an urban Indian
					 organization receiving funds under Title V of the Indian Health Care
					 Improvement Act as of October 1, 1991.
09.01-5
Indian Health Center Unit of
					 Service
is a visit that includes face-to-face contact with one or more
					 of the clinic's professional staff and, where appropriate, provision of
					 treatment, supplies, or laboratory services.
09.01-6
Indian Tribe, Tribal
					 Organization, or Urban Indian Organization (I/T/U)
means any of the
					 following: 
					 
												an "Indian Tribe," meaning any Indian tribe, band,
						  nation, or other organized group or community, including any Alaska Native
						  village or group or regional or village corporation as defined in or
						  established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688,
						  43 U.S.C.
						  §§
														1601 et seq.) which is
						  recognized as eligible for the special programs and services provided by the
						  United States to Indians because of their status as Indians;
												a "Tribal Organization," meaning the elected
						  governing body of any Indian tribe or any legally established organization of
						  Indians which is controlled by one or more such bodies or by a board of
						  directors elected or selected by one or more such bodies (or elected by the
						  Indian population to be served by such organization) and which includes the
						  maximum participation of Indians in all phases of its activities; or
												an "Urban Indian Organization," meaning a nonprofit
						  corporate body situated in an urban center, governed by an urban Indian
						  controlled board of directors, and providing for the maximum participation of
						  all interested Indian groups.
and individuals, which body is capable of legally
						cooperating with other public and private entities for the purpose of
						performing the activities described in §503(a) of the Indian Health Care
						Improvement Act (90 Stat. 1400,
						42 U.S.C.
						§1653(a) ).