C.M.R. 10, 144, ch. 505 - APPROPRIATENESS REVIEW PROCEDURES AND CRITERIA

Summary: These rules govern the implementation of the Department's appropriateness review function mandated under Section 1523(a)(6) of PL 93-641, the National Health Planning and Resources Development Act of 1974, as amended. This Act requires the review on a periodic basis of all institutional health services offered in the state, and the publication of findings by the Department after consideration of recommendations made by the Maine Health Systems Agency, Inc. with respect to the appropriateness of such services,

These review procedures and criteria include definitions of terms, a listing and definitions of services to be reviewed, a schedule for review of these services, procedures for review, types of information required and criteria to be considered in the conduct of appropriateness reviews in the areas of service availability, accessibility, quality, continuity, cost and other related factors,

BASIS STATEMENT:

These rules are adopted to implement the Department's appropriateness review function mandated under Section 1523(a)(6) of PL 93-641, the National Health Planning and Resources Development Act of 1974, as amended. The appropriateness review function is a planning process designed to influence the health care system by assessing the appropriate level of existing institutional health care services within the State of Maine. It is intended to result in careful area-wide or institution-specific reviews by the Maine Health Systems Agency, Inc. and the State Bureau of Health Planning and Development of all existing institutional health services, the publication of appropriate levels of institutional health services and findings regarding the appropriateness of existing institutional health services and recommendations for action to bring health services into line with appropriate levels as established during the process.