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 I - Specific Policies By Service › Sec2 144-101-I-1 - GENERAL ADMINISTRATIVE POLICIES AND PROCEDURES › Subsection 144-101-I-1.06 - COVERED AND NON-COVERED SERVICES

Current through 2024-29, July 17, 2024
1.06-1
Covered Services
All covered services reimbursable by MaineCare must be
						medically necessary and described in the MBM. MaineCare members are eligible
						for as many covered services as are medically necessary and within the
						limitations outlined in applicable sections of this Manual. The Department
						reserves the right to require additional medical opinions or evaluations by
						appropriate professionals of its choice concerning medical necessity or
						expected therapeutic benefit of any requested service.
Covered services include those services described in
						other Chapters of this Manual and other medically necessary health care,
						diagnostic services, treatment, and other measures, as required by the
Omnibus Reconciliation Act of 1989
.
These services are intended to correct or ameliorate
						defects and physical and mental illnesses and conditions discovered by the
						screening services described in the Manual sections applicable to EPSDT for
						members under age twenty-one (21), whether or not such services are (otherwise)
						covered under the Medicaid State Plan as long as they would otherwise be
						federally allowable under the State Plan.
1.06-2
Interpreter Services
A. Providers must ensure that MaineCare
					 members are able to communicate effectively with them regarding their medical
					 needs. MaineCare will reimburse providers for interpreters required for limited
					 and non-English speaking members and/or deaf/hard of hearing members, when
					 these services are necessary and reasonable to communicate effectively with
					 members regarding health needs. Interpreter services can only be covered in
					 conjunction with another covered MaineCare service or medically necessary
					 follow-up visit(s) to the initial covered service.
MaineCare will pay for two (2) interpreters for deaf
						MaineCare members who use a sign language other than American Sign Language or
						who use a unique non-spoken method of communication and require a relay
						interpreting team including a deaf interpreter working with a hearing
						interpreter.
B. Family
					 members or personal friends may be used as interpreters, but cannot be paid.
					 "Family" means any of the following: husband or wife, natural or adoptive
					 parent, child, or sibling, stepparent, stepchild, stepbrother or stepsister,
					 father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law,
					 sister-in-law, grandparent or grandchild, spouse of grandparent or grandchild
					 or any person sharing a common abode as part of a single family unit.
Family members or friends, with the exception of those
						individuals under the age of 18, may be used as non-paid interpreters
						if:
1. requested by the member; and
2.  the use of this friend or
					 family member does not compromise the effectiveness of services or violate the
					 member'sconfidentiality; and
3. the
					 member is advised that an interpreter is available at no charge to the
					 member.
C. If a paid
					 interpreter is hired, providers can select the interpreter. However, should the
					 interpreter provide transportation to the member, MaineCare will not reimburse
					 the interpreter for transporting the member while concurrently billing for
					 interpreter services. All interpreter services must be provided in accordance
					 with the
Americans with Disabilities Act
.
D. A provider may not bill MaineCare for an
					 interpreter service supplied by an entity in which the provider, any owner of
					 the provider, or an immediate family member of the provider or any of its
					 owners has any direct or indirect ownership or financial interest, unless:
1. The provider also reimburses other
					 entities for the provision of interpreter services; and 2. The entity providing
					 the interpreting service makes those services commercially available to
					 MaineCare providers or other businesses that do not share a direct or indirect
					 familial ownership interest with the interpreting entity.
E. When providers request reimbursement for
					 any interpreter services, the services must be included in the member record.
					 Documentation must include a statement verifying the interpreter
					 qualifications, date, time and duration of service, language used, the name of
					 the interpreter, and the cost of performing the service.
F. Providers are responsible for ensuring
					 that interpreters protect patient confidentiality and adhere to an interpreter
					 code of ethics. Providers shall document that interpreters have provided
					 evidence of having read and signed a code of ethics for interpreters equivalent
					 to the model included as Appendix #1. This shall be deemed as compliance with
					 this requirement.
G. Providers of
					 interpreter services must be licensed by the Maine Department of Professional
					 and Financial Regulation as Certified Interpreters/Transliterators, Certified
					 Deaf Interpreters, Limited Interpreters/Transliterators, or as Limited Deaf
					 Interpreters.
H. Providers must use
					 the following code when billing for interpreter services for deaf/hard of
					 hearing members and non-English speaking members:
T1013
Sign language or oral interpreter
						services per fifteen minutes.
The actual billable amount should be the lesser of the
						interpreter's usual and customary charge and the rate authorized by the
						Department.
Any other codes for interpreter services listed in the
						specific service sections of the MBM are no longer valid.
I. Providers may use language interpreter
					 services conducted via telephone or other audio/video means. These services may
					 come from local resources, national language interpreter services such as
					 LanguageLine Solutions or comparable services. Wherever feasible, providers
					 should use local and more cost-effective interpreter services.
When billing for language interpreter services conducted
						via telephone or other audio/video means, providers should use the T1013
						procedure code with a GT modifier and include copies of the invoice with the
						claim. Reimbursement is by invoice.
J.
Exceptions and Limitations
1. Hospitals, ICF/IID Intermediate Care
					 Facility for Individuals with Intellectual Disabilities, and nursing facilities
					 may not bill separately for either language or deaf/hard of hearing interpreter
					 services. For hospitals, ICF/IIDs, and nursing facilities, these costs will be
					 allowable and are included in the calculation of reimbursement.
2. The Department will not pay for
					 interpreter services when there is a primary third party payer if the primary
					 third party payer is required to cover the interpreter services.
3. The Department will not reimburse for
					 interpreter travel time or wait time.