Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 505 - APPROPRIATENESS REVIEW PROCEDURES AND CRITERIA › Section 144-505-2 - SERVICES TO BE REVIEWED

Current through 2024-29, July 17, 2024
A. Existing
				institutional health services will be reviewed by the Maine Health Systems
				Agency, Inc. according to the review schedule which follows. Completion dates
				shown in the following schedule represent, to the extent practicable, the date
				on which the MHSA Board of Trustees shall forward its recommendation to the
				Bureau of Health Planning and Development. The Bureau of Health Planning and
				Development will complete its review and publish its findings with respect to
				each scheduled institutional health service within one year of the receipt of
				an appropriate recommendation from the Maine Health Systems Agency, Inc.,
				provided that the Agency completes its review on a timely basis. If the MHSA
				fails to make such a timely recommendation, the Bureau shall provide notice of
				the beginning of its review not later than 120 days after the scheduled
				completion of the MHSA's review as shown in the following schedule. If the MHSA
				subsequently completes its review of the scheduled institutional health service
				and forwards its recommendation with respect to the appropriateness of such
				services to the Bureau prior to the date on which the State agency makes its
				decision, the State agency will consider the MHSA's recommendation.
B. Schedules for Review
MHSA
MHSA
Start Date
End Date
Open Heart Surgery Services
11/1/80
4/30/81
Cardiac Catheterization Services
11/1/80
4/30/81
Megavoltage Radiation Therapy Services
2/l/80
7/31/81
Computerized Axial Tomographic
Scanning Services
2/l/81
7/31/81
End Stage Renal Dialysis Services
6/l/81
11/30/81
Neonatal Special Care Nurseries
8/1/81
1/31/82
Pediatric Care Services
8/1/81
1/31/82
Obstetrical Care Services
8/1/81
1/31/82
Intermediate Care Facilities
12/1/81
5/31/82
Skilled Nursing Facilities
12/l/81
5/31/82
Home Health Care Services
12/l/81
5/31/82
Psychiatric Care Services
3/l/82
8/31/82
Chemical Dependency Services
3/l/82
8/31/82
ICU/CCU Service
7/l/82
12/11/82
Medical/Surgical Services
7/l/82
12/11/82
C.
				Definition of Services
1. open Heart Surgery
				Services. Services dealing with a class of highly technical operations on the
				heart and intrathoracic great vessels which requires temporary use of
				cardiopulmonary bypass equipment to perform the functions of circulation during
				surgery.
2. Cardiac Catheterization
				Services. Services associated with procedures for diagnosing disorders of the
				heart, lung, and the great vessels with the resource capability to insert
				catheters into the heart and adjacent great vessels, to reliably measure
				multiple parameters of cardiac physiological activity and to obtain
				visualization of the appropriate heart chambers and adjacent vessels.
3. Megavoltage Radiation Therapy Services.
				Services associated with a field within medicine which employs the use of high
				energy ionizing radiation for the treatment of disease.
4. Computerized Axial Tomographic Scanning
				Services. Services associated with a diagnostic imaging device which uses a
				computer to analyze the differential strength of X-ray beams passed through
				body tissues in order to locate and identify abnormalities.
5. End Stage Renal Disease Services: Services
				associated with the stage of renal impairment which is almost always
				irreversible and permanent, and requires dialysis or kidney transplantation to
				maintain life. ESRD services include, but are not limited to, the following,
				which are provided in health care facilities:
a Renal dialysis - a process by which waste
				products and excess fluid are removed from an ESRD patient's body by osmosis
				from one fluid compartment to another hemodialysis and peritoneal
				dialysis);
b Renal transplantation
				- a process by which a kidney is excised from a live or cadaveric donor and
				such kidney is implanted in an ESRD patient and supportive care is furnished to
				the living donor and to the recipient following implantation.
6. Neonatal Special Care
				Nurseries. Specialized nursing units which concentrate on seriously ill
				neonates needing constant observation and specialized support equipment and
				care. Neonatal special care units usually take on a regionalized configuration
				with three specific levels of care:
a Level
				I. A Level I unit primarily provides services for uncomplicated maternity and
				newborn patients with critical consideration given to the earliest possible
				detection of the "high-risk" maternity and newborn patient and the capability
				to provide emergency obstetric and newborn care;
b Level II. A Level II unit provides a full
				range of maternal and neonatal services for uncomplicated patients and for the
				majority of complicated obstetrical problems and certain neonatal illnesses.
				Level II units are those which are equipped either to provide for in-hours
				patients only (nonreferral) or for both in-house and referral patients
				(referral).
c Level III. A Level
				III unit provides care for normal patients but especially for all the serious
				types of maternal-fetal and neonatal illnesses and abnormalities. Level III
				units provide continuing education to improve the overall quality of care and
				generate, develop, and evaluate new concepts and techniques in prenatal and
				perinatal pare. A Level III unit may be actively engaged in clinical and basic
				research related to perinatal health. Pediatric Care Services. Inpatient and
				outpatient services provided in health care facilities to care for medical/and
				or surgical patients less than 14 years old, excluding neonatal special care
				nurseries.
8.
				Obstetrical Care Services. Inpatient and outpatient services provided in health
				care facilities to maternity and newborn patients. Also see "Neonatal Special
				Care Nurseries" in this section for definition of level of care designations
				for obstetric services.
9.
				Intermediate Care Facilities. Facilities licensed or certified by the
				Department of Human Services as intermediate care facilities to provide
				medically and socially oriented nursing care necessitating licensed nursing
				supervision and/or services and/ or medical therapy of a moderately complex yet
				specific nature on a long-term basis. This care would meet the current health
				needs and promote The maximum physical and psychosocial well-being of patients
				receiving such care.
10. Skilled
				Nursing Facilities. Facilities licensed or certified by the Department of Human
				Services as skilled nursing facilities to provide skilled nursing care -- a
				service necessitating skilled nursing techniques and/or medical therapy of a
				complex and/or intensive degree on a long-term basis. The care would meet the
				current health needs and promote the maximum physical and psychosocial
				well-being of patients receiving such care. on a 24-hour basis. Licensed
				nursing care and supervision is required.
11. Home Health Care Services. A health care
				service provided by an agency in a patient's residence for pay or other
				consideration according to a written and signed plan of treatment prescribed by
				a physician. The health care services provided in a patient's residence include
				nursing care, physical therapy, occupational therapy, speech therapy, medical
				social service, home health aide, furnishing medical supplies, and nutritional
				counseling.
12. Psychiatric Care
				Services. A service provided by hospitals or other health care facilities which
				deals with the study, treatment, and prevention of mental illness.
13. Chemical Dependency Service. An acute
				inpatient or outpatient service which specializes in the treatment of patients
				with substance addiction.
14.
				ICU/CCU Service. A specialized nursing service or unit which concentrates
				within one area of a hospital seriously ill patients needing constant nursing
				care and observation. The service may limit itself to the care of just cardiac
				patients, or may serve a mixed population.