| | | 2.__Rules.__The department shall adopt rules to implement | | MaineCare Basic in accordance with this section.__Rules adopted | | pursuant to this section are routine technical rules as defined | | in Title 5, chapter 375, subchapter 2-A. |
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| | | 3.__Services.__The rules adopted pursuant to subsection 2 must | | provide for access to medically necessary services as provided in | | the federally approved Medicaid state plan.__Benefits for certain | | services are limited as follows. |
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| | | A.__A member is eligible for speech therapy benefits if the | | member has been assessed to have rehabilitation potential | | and has been documented by a physician to have experienced a | | significant decline in ability to communicate orally, safely | | swallow or masticate.__Speech therapy benefits must cover | | one initial evaluation of the member per provider per year | | and one reevaluation every 6 months per provider.__Speech | | therapy benefits must cover outpatient therapy provided in | | the home, independent practitioners' offices and speech and | | hearing clinic sites. |
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| | | B.__A member is eligible for rehabilitation services | | benefits for brain injury subject to levels of care | | determined by rule. |
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| | | C.__A member is eligible for psychological services benefits | | for individual and group counseling.__Benefits for one or | | both types of counseling combined are limited to a total of | | 16 one-hour visits per year. |
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| | | D.__A member is eligible for benefits for durable medical | | equipment, prosthetics and orthotics for one pair of shoes | | and one pair of inserts per year, medical supplies required | | to meet standard daily needs and power wheelchairs for a | | member who is nonambulatory and has a significant | | neuromuscular disease or disorder. |
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| | | E.__A member is eligible for occupational and physical | | therapy benefits provided by occupational and physical | | therapists licensed under Title 32 and who are acting within | | their scope of practice.__Services of occupational and | | physical therapists may be provided in all outpatient | | settings, including the home.__For services subject to this | | paragraph, the department may require a member to have that | | member's rehabilitation potential documented by a physician | | and may limit treatment to: |
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| | | (1)__Treatment following an acute hospital stay for a | | condition affecting range of motion, muscle strength | | and physical functional abilities; |
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