| | | (2)__Benefits for outpatient visits to a hospital are | | limited to 5 per year, except that more visits may be | | approved through prior authorization by the department.__ | | This subparagraph does not limit benefits for visits | | for laboratory services, x-ray services, prenatal care | | and mental health diagnoses. |
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| | | (3)__Benefits for brand-name prescription medications | | are limited to 5 medications dispensed during the same | | time period, except that benefits for additional brand- | | name medications may be approved through prior | | authorization by the department.__In addition to the | | brand-name limitation, as compared to members who are | | eligible under other paragraphs of section 3174-G, | | subsection 1, prescription medication benefits for | | members who are eligible under paragraph F are limited | | by stricter prior authorization requirements, increased | | review of pharmacy use and a request for federal | | permission to waive freedom of choice. |
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| | | (4)__A member who is eligible for benefits under | | section 3174-G, subsection 1, paragraph F begins | | coverage on the date that the department determines | | that the member is eligible. |
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| | | Sec. MMM-2. Service limitation or rate reduction. Home-based care program | | benefits administered by the Department of Human Services may be | | limited by reductions in units of service or by rate reductions | | for fiscal year 2004-05 in order to achieve savings of $466,666 | | in General Fund expenditures in the program budget. |
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| | | Sec. MMM-3. Savings in MaineCare expenditures. The Department of Human | | Services is authorized to adopt routine technical rules in the | | MaineCare program in accordance with Title 22, section 3174-FF to | | achieve savings for the General Fund in the following amounts in | | fiscal year 2004-05: speech therapy, occupational therapy and | | physical therapy, $297,714; chiropractic, $80,873; durable | | medical equipment, $350,000; prosthetics and orthotics, $43,094; | | rehabilitation for brain injury, $1,500,000; psychological | | services, $125,740; private duty nursing and waiver programs for | | persons who are elderly or disabled, $233,333; noncategorical | | members' inpatient care, $482,374; noncategorical members' | | outpatient care, $945,841; noncategorical members' prescription | | medications, $200,000; and noncategorical members' prospective | | eligibility, $560,859. |
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| | | Sec. MMM-4. Appropriations and allocations. The following | | appropriations and allocations are made. |
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