Ch. 105: Catastrophic Illness Program

BUREAU OF MEDICAL SERVICES Chapter 105: CATASTROPHIC ILLNESS PROGRAM SUMMARY STATEMENT: The amendment to the rule reflects recent statutory changes in the Catastrophic Illness Program that terminates hospital services coverage for eligible recipients on or after May 1, 1984. STATE OF MAINE MEDICAL ASSISTANCE PROGRAM (MEDICAID OR TITLE XIX) AND CATASTROPHIC ILLNESS PROGRAM MEDICAID PROGRAM Categorically Medically Catastrophic Services Covered Needy (MM) Needy (MI) Illness Program (CI) Ambulance Services X X X*1 Audiology Services X*2 X*2 0 Chiropractic Services X X 0 Dental Services X*3 X*3 X*4 Family Planning Services X X 0 Hearing Aids and Services X*2 X*2 0 Home Health Services X X 0 Hospital (Inpatient/Outpatient) X X X*5 *9 Intermediate Care Facility Services X X 0 Laboratory and X ray Services X X X Medical Supplies and Equipment X X X Mental Health Clinic Services X X 0 Opticians Services X*6 X*6 0 Optometrist Services X*6 X*6 0 Pharmacy Services X X X Physical Therapy Services X X X Physician Services X X X*7 Podiatrist Services X X 0 Psychological Services X 0 0 Certified Rural Health Clinic Services X X 0 Skilled Nursing Facility Services X X X*8 Speech Pathology Services X X 0 __________________________________________________________________________________________ X services covered with limitations as noted and described in the Maine Medical Assistance Manual 0 Services not covered. __________________________________________________________________________________________ *1 = Ambulance services covered only to the "nearest" hospital or medical facility which can provide acute care needed. *2 = Hearing Aids and exams for fitting them covered only for persons under 21 included in the EPSDT Program. *3 = Dental Services covered only for persons under 21 included in the EPSDT Program, except for acute care related to traumatic injury and certain oral surgical and related medical procedures not involving the dentition and gingiva

r medical facility which can provide acute care needed. *2 = Hearing Aids and exams for fitting them covered only for persons under 21 included in the EPSDT Program. *3 = Dental Services covered only for persons under 21 included in the EPSDT Program, except for acute care related to traumatic injury and certain oral surgical and related medical procedures not involving the dentition and gingiva. *4 = Catastrophic Illness Program recipients are covered for only acute dental care related to a traumatic injury and certain oral surgical and related medical procedures not involving the dentition and gingiva. (Effective 7/13/82) *5 = The term hospital shall include an accredited Christian Science sanatorium instead of a medical hospital. (Currently the nearest facility for Christian Scientists is in Boston, so arrangement would need to be processed under the provision for out of state services). *6 = Eyeglasses covered only for persons under 21 included in the EPSDT Program, except for glasses following eye surgery. *7 = Psychiatric services are not covered. *8 = SNF Services limited to 60 days per year, must be admitted within 7 days following no less than 5 days of hospitalization. *9 = Effective on and after May 1, 1984. inpatient hospital and outpatient hospital services are not covered by the Catastrophic Illness Program.