02-031 C.M.R. ch. 320, § 4 - Definitions

For purposes of this Rule, the following terms have the following meaning:

A. "Usual Charge" means the most consistent charge by a provider for a given service.

B. "Customary Charge" means a charge within the range of usual charges for a given service billed by most providers with similar training and experience taking into consideration the geographic area in which the services are provided and significant regional variations in the cost of services.

C. "Reasonable Charge" means a charge that is not more than the usual and customary charge.

D. "Allowable Charge" means the amount which would be payable for services of a preferred provider under a preferred provider arrangement prior to the application of any deductible or coinsurance.

E. "Residential Treatment" means those services defined by Title 24, Section 2329, subsection 2, paragraph B, or Title 24-A M.R.S.A., Section2842, subsection 2, paragraph B, whether billed by the facility or by a physician or other professional.

F. "Non-residential Day Treatment" means a program of outpatient care involving visits of more than two hours but less than 24 hours per day, at least three days per week.

G. "Substance Abuse" means the illnesses of alcoholism and drug dependency as those terms are used in 2329, and 2842 Section .

Notes

02-031 C.M.R. ch. 320, § 4