Adopted Rule: MaineCare Benefits Manual, Chapter II, Section 90, Physician Services


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The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes.  The MaineCare Benefits Manual is available on-line at the Secretary of State’s website


Below, please find a notice of Agency Rule-making Adoption. You can access the complete rule at

Notice of Agency Rule-making Final Adoption 

AGENCY: Department of Health and Human Services, Office of MaineCare Services


CHAPTER NUMBER AND TITLE:  10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter II, Section 90, Physician Services




CONCISE SUMMARY: On June 18, 2019, the Department adopted an emergency Ch. II, Sec. 90 rule, which eliminated “transsexual procedures” from the list of non-covered services in § 90.07. Elimination of this prohibition on transgender medical procedures complies with Section 1557 of the Affordable Care Act (Pub. L. 111-148, title I, Sec. 1557), as codified in 42 U.S.C § 18116 and its enabling regulation, 45 C.F.R. Part 92, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. This adopted rule makes that change permanent.


In addition, the Department is adopting the following changes in this rulemaking:  

  1. The addition of Appendix A as the last item on the Table of Contents, which was part of the rule previously but was not identified in the Table of Contents; 
  2. From the Supplies and Materials category, removal of language “that may be reimbursed as separate items” to add clarity as to what is reimbursable for medical supplies and materials under this section (90.01-5). Language about supply reimbursement already exists under Medical Supplies & Durable Medical Equipment (90.04-9);
  3. Addition of language setting the reimbursement for physician’s medical direction of anesthesia services at 50% of the allowance when a physician performs anesthesia services alone (90.04-1(B)) to more closely align with the Centers for Medicare and Medicaid Services’ (CMS) reimbursement methodology;
  4. Amended the provision in the policy specifying how interns, residents, and locum tenens are enrolled to require that residents, locum tenens, and temporaries to enroll either under a physicians’ group or as a hospital-based professional in order to be reimbursed through MaineCare (90.04-10). The Department added the requirement that residents must have a medical license for best practices (per Title 32, ch. 48, § 3271(2)) to enroll and receive reimbursement through MaineCare;
  5. Removal of mileage reimbursement language to create consistency across the MaineCare Benefits Manual and minimize abuse of mileage reimbursement. (90.04-11);
  6. Addition of two new services: Diabetes Self-Management Training Services (DSMT) (90.04-13) and Medical Nutrition Therapy Services (MNT) (90.04-14). DSMT and MNT have been linked to improved clinical outcomes.
  7. Addition of licensed dietician as an “other” professional that can work in association with Physician Services (90.04-15), and who can also provide the newly added DSMT or MNT services;
  8. Addition of licensed clinical psychologists and licensed marriage and family therapists as “other” professionals practicing within the scope of their licensure that can work in association with Physician Services (90.04-15);
  9. Addition of clarifying language for current and accurate prescribing criteria in the Prescriptions category of Covered Services (90.04-19);
  10. Addition of transgender services (90.04-33) under Covered Services to identify coverage for medically necessary procedures. The Department had proposed to put this provision under Restricted Services, requiring prior authorization. In response to comments, the Department moved this provision to the covered services section so that prior authorization is not required for these non-surgical services;
  11. Addition of (90.05-1 A (4)) Gender Dysphoria Related Surgeries to identify coverage for surgeries for the treatment of gender dysphoria. Commenters agreed that prior authorization should be required for surgeries;
  12. Amendment to provider title under Restricted Services (90.05-2 A) Abortion Services, from physician to health care professional to comply with PL 2019, c. 262, An Act to Authorize Certain Health Care Professionals to Perform Abortions. This change is effective September 19, 2019;
  13. The Reimbursement Rate for Drugs Administered by Other Than Oral Methods (90.09-3) has been amended to align MaineCare policy with the CMS Covered Outpatient Drug final rule by determining drug fee schedules as Average Sales Price (ASP), plus 6%, as set by Medicare Part B for Maine area “99”; and
  14. Removal of the Member Satisfaction category under the Primary Care Provider Incentive Payment (90.09-4) list of incentives. A separate category for this is not required because member satisfaction is a targeted indicator built into the scoring of the various categories. for rules and related rulemaking documents.

See for rules and related rulemaking documents. 

AGENCY CONTACT PERSON:  Anne E. Labonte, Comprehensive Health Planner II

AGENCY NAME:  Division of Policy

ADDRESS:  109 Capitol Street, Augusta, Maine 04333-0011

TELEPHONE:  (207)-624-4082   FAX: (207) 287-6106       TTY users call Maine relay 711