ࡱ> []Zq` m)bjbjqPqP 48::5!7       44448l x,4|D.~-U%C$EhH>!D !D  6DJJJd  ~J~JJ  J 0Q 4*dJjLD0|DJPHdPHJPH J J!D!DX|D444       10-144 DEPARTMENT OF HUMAN SERVICES Chapter 504: RULES FOR IMPLEMENTING THE 1985 AMENDMENTS TO THE MAINE MEDICAL COMPACT ACT AND MAINE OSTEOPATHIC STUDENT LOAN PROGRAM Summary: This rule establishes definitions, procedures, and criteria necessary for the implementation of amendments to the fb88 Medical Compact Act passed by the 112th fb88 Legislature to become effective retroactively to July 1, 1981. 1. Definitions The following words and phrases shall have the following meanings: a. Family/General Practitioner (for the purposes of determining eligibility for forgiveness) - a licensed physician whose practice assumes continuing responsibility for supervising the health and coordinating the care of all family members, regardless of age. This practitioner generally provides the basic medical services given when a patient first seeks assistance from the medical care system and provides for care of the simpler and more common illnesses. The provider of these services usually also assumes ongoing responsibility for the patient in both health maintenance and therapy of illness. These services are comprehensive in the sense that the provider takes responsibility for the coordination of the care of the patient's health problems, be they biological, behavioral or social. The appropriate use of consultants and community resources is an important part of an effective family/general medical practice. Such work demands specific skills including functioning as a medical manager, advocate, educator and counselor for the patient. b. Pediatric Practitioner (for the purposes of determining eligibility for forgiveness) - a licensed physician whose practice assumes responsibility for providing continuing medical care dealing with the development of infants, children, and adolescents, and with the treatment of their diseases, along with counseling and prevention. c. Primary Care Physicians (for the purpose of determining underserved areas) - are active doctors or medicine (MD) and doctors of osteopathy (D.O.) who spend at least 60 percent of their active practice time engaged in direct patient care in the medical fields of general or family practice, pediatrics, internal medicine, or obstetrics and gynecology. These fields of medicine are defined through use of the American Medical Association Specialty and Osteopathic Physician Practice Area classification as reported in the Bureau of Health Planning and Development's Cooperative Health Manpower Resources Inventories. For this purpose, no distinction shall be made between civilian physicians and National Health Service Corps physicians and other federal physicians (except those who exclusively serve Indiana or an military bases). d. Underserved Geographic Area - is a Primary Care Analysis Area (PCAA), population group specialty area, or service area that meets the criteria stated below in Section 3 of this rule. e. Full-Time- Equivalent Primary Care Physician - in a primary care physician who provides patient care an average of forty hours per week. For primary care physicians who provide patient care for fewer than forty hours per week, every four hours spent in providing patient care will be counted as a 0.1 full-time equivalent. f. Population to Primary Care Physician Ratio - is determined by dividing the population of a Primary Care Analysis Area by the number of full-time equivalent primary care physicians who practice within the Area. The ratio for each Primary Care Analysis Area will be expressed as a number of people per one primary care physician (e.g., 2100:1). g. Contiguous Area-Primary Care Providers - are those primary care physicians who are located in areas that are contiguous to the PCAA that is being considered for placement of a contract student. Contiguous area primary care providers will be considered overutilized if the population to primary care physician ratio exceeds 1500:1 in the contiguous area. 2. Procedures No later than June I of each year, beginning in 1987, the Commissioner of Human Services shall designate underserved areas. Such areas shall be those Primary Care Analysis Areas, population group specialty areas, or service areas which meet the criteria for underservice defined below in Section 3. Federally designated health manpower shortage areas and medically underserved areas will automatically become state designated. The designations for underservice shall be in effect for one year from the date of designation. The Commissioner of Human Services, in making such designations, shall utilize the Department's Cooperative Health Manpower Resource Inventories, the Primary Care Analysis Areas as defined in the most recent State Health Plan for fb88, the most current population estimates prepared by the State Planning Office or the Office of Health Planning and Development, and such other information as may be available and appropriate. Before designating underserved areas, the Commissioner of Human Services will provide au opportunity for the Advisory Committee on Medical Education to review and comment on the list of areas be proposes to designate. The number of physicians who any establish practices in the same underserved area in any one year to be eligible for forgiveness of their obligations will be limited to the number that is required to achieve a population to primary care physician ratio of less than 2000:1. In making his designations of underserved areas, the Commissioner will count, as part of the total number of primary care providers in an area, those primary care practitioners who were contract students and who established practices in those areas to have their loans forgiven under this Act. Those practitioners will continue to be eligible for forgiveness if they continue to practice in an area that was designated as underserved when they established their practice, regardless of whether or not the area is designated as an underserved area in subsequent years. 3. Criteria. A. The Commissioner of Human Services will designate a Primary Care Analysis Area as underserved if: 1) it has a population to primary care physician ratio of 3000 or morel; and, 2) contiguous area primary care resources are overutilized and/or are in excess of 15 miles travel by secondary roads or 20 miles by primary roads or 25 miles by turnpike or interstate highway. B. The Commissioner of Human Services may designate a Primary Care Analysis Area as underserved if it has a population to primary care physician ratio of between 2,000 and 2,999:1, if, in his judgment, other factors indicate the likelihood of the area's population being underserved and contiguous area primary care resources being overutilized and/or excessively distant as defined in 3.A.2 above. Such factors will include but are not limited to: 1. Insufficient capacity of the Area's existing primary care providers to serve the area's population. Insufficient capacity as determined by the Department say be indicated by any of the following: a) Unusually long waits for appointments for routine medical services (i.e., more than 7 days for established patients and 14 days for new patients); b) Excessive average waiting time at primary care providers (longer than out hour where patients have appointments or two hours where patients are treated on a first-come, first-served basis); c) Evidence of excessive use of emergency room facilities for routine primary care; d) A substantial proportion (2/3 or more) of the area's physicians do not accept new patients; e) A substantial proportion (213 or more) of the area's physicians do, not accept Medicaid patients. 2. Unusually high health needs of the area's population. Such health needs may be indicated by the following: a) The area has sore than 100 births per year per 1,000 women aged b) The area has more than 20 infant deaths per 1,000 live births; c) More than 20% of the population (or of all households) have incomes below the poverty level; d) The area has an incidence rate for preventable and communicable diseases which is higher than the statewide rate; e) The population has a hospital admission rate for diseases or conditions which could have been prevented or treated on an ambulatory basis which is higher than the statewide rate. STATUTORY AUTHORITY: 20-A M.R.S.A. Sec. 11804 EFFECTIVE DATE: September 24, 1983 AMENDED: November 22, 1987 EFFECTIVE DATE (ELECTRONIC CONVERSION): May 5, 1996     10-144 Chapter 504 page page 1 5)6)8)9);)<)>)?)A)`)a)f)g)h)i)j)l)m)%hfTPCJOJQJ^JaJmHnHu#jh-H^CJOJQJU^JaJh-H^CJOJQJ^JaJh-H^jh-H^Uh-H^CJOJQJ^JaJ%& hijk p@ `^`` p@  p@ p^p` p@ 0^`05)l)xyzDE !nop}~ ""# p@ p^p` p@ 0^`0 p@ `^``##$$$$:%;%%%&&x&y&&&&'`'a''' p@ @ 0^@ `0 p@ p^p` p@ @ ^@ ` p@ 0^`0'(((((((()5)7)8):);)=)>)@)A)B)C)D)j)k)l)$a$ p@ 0^`0 p@ @ 0^@ `0l)m) p@ 0^`02 00P/ =!"#$% P@P Normal'CJOJQJ^J_HkHmH sH tH uDA@D Default Paragraph FontRi@R  Table Normal4 l4a (k@(No List4 @4 Footer  !4@4 Header  !m!8 666669m)#'l)m)l)+139!4!5!5!7!7!8!8!:!;!=!>!@!A!`!i!n!4!5!5!7!7!8!8!:!;!=!>!@!A!`!i!n!4!5!5!7!7!8!8!:!;!=!>!@!A!`!i!n!5!5!7!7!8!8!:!;!=!>!@!A!k!n!fTP-H^5!n!@LocalNe02:winspoolHP LaserJet 2420 PCL 5eLocalC odXXLetterDINU" I>SMTJHP LaserJet 2420 PCL 5eInputBinFORMSOURCERESDLLUniresDLLResolution600dpiOrientationPORTRAITHPOrientRotate180FalseDuplexNONEPaperSizeLETTERMediaTypeAUTOCollateONESPRITSupportedTrueHPPaperSizeALMConstraintsENV_10EconomodeFalseTextAsBlackFalseHPEnableRAWSpoolingTrueTTAsBitmapsSettingTTModeOutlineGraphicsModeRASTERMODERETChoiceTrueAlternateLetterHeadFalsePrintQualityGroupPQGroup_1HPColorModeMONOCHROME_MODEHPPDLTypePDL_PCL5HPMaxResolutionPDM_600DPIHPPJLEncodingUTF8HPJobAccountingHPJOBACCT_JOBACNTHPSmartDuplexSinglePageJobTrueHPSmartDuplexOddPageJobTrueHPJobByJobOverrideJBJOHPManualDuplexDialogItemsInstructionID_01_FACEDOWN-NOROTATEHPPaperSizeDuplexConstraintsSTATEMENTHPMediaTypeDuplexConstraintsEXTRA_HEAVYHPManualFeedOrientationFACEDOWNHPOutputBinOrientationFACEDOWNHPManualDuplexDialogModelModelessHPManualDuplexPageOrderEvenPagesFirstHPMapManualFeedToTray1TrueHPManualDuplexPageRotateDriverRotateHPPrintOnBothSidesManuallyFalseHPStraightPaperPathFalseHPPosterPrintingFalseHPPosterPrintingOptionPOSTER_2HPNUseDiffFirstPageChoiceTRUEHPPageExceptionsFilehpcPE5r1HPPageExceptionsInterfaceShowPageExceptionsHPPageExceptionsLowEndHPPageExceptionsLowEndVerHPPageExceptionsCoverInsertionHPDuplicateJobNameOverrideSWFWHPDocUISUITruePSAlignmentFilehpcLS5r1PSServices_DeviceandSuppliesStatusTRUEHPSmartHub_OnlinediagnostictoolsTRUEHPSmartHub_SupportandtroubleshootingTRUEHPSmartHub_ProductmanualsTRUEHPSmartHub_CheckfordriverupdatesTRUEHPSmartHubInet_SID_263_BID_276_HID_265PSServicesOptionPrnStat_SID_242_BID_270_HID_15521HPDocPropResourceDatahpchl5r1.cabHPConsumerCustomPaperHPCustomJRConstraintsJRCHDPartialJRHDInstalledJRHDOffJRHDNotInstalledJRHDOffHPJobAccWoPinTrueHPXMLFileUsedhpc24205.xmlIUPHxn@'B\BٱHYA vJED\T)Mv@W@<<,y s)HF3gƗf|)P1SCSuXg 8 lib18LF mJ;\ao!hVQG3xrVz:q~=W[ѤG"-qp/N j,i߳COKY0QaCj;#"Ӂ|6qof|؜6,~ ͘^; 0||;f/Gc5eP*ɹˮOR$-<Ή6.6ti]dkԊL%m%3ttc>lpG0-4~g9]΁I{ov'`gَ8myӅ7 n ]óg6/}-FZAAA=/cLLocalC odXXLetterDINU" I>SMTJHP LaserJet 2420 PCL 5eInputBinFORMSOURCERESDLLUniresDLLResolution600dpiOrientationPORTRAITHPOrientRotate180FalseDuplexNONEPaperSizeLETTERMediaTypeAUTOCollateONESPRITSupportedTrueHPPaperSizeALMConstraintsENV_10EconomodeFalseTextAsBlackFalseHPEnableRAWSpoolingTrueTTAsBitmapsSettingTTModeOutlineGraphicsModeRASTERMODERETChoiceTrueAlternateLetterHeadFalsePrintQualityGroupPQGroup_1HPColorModeMONOCHROME_MODEHPPDLTypePDL_PCL5HPMaxResolutionPDM_600DPIHPPJLEncodingUTF8HPJobAccountingHPJOBACCT_JOBACNTHPSmartDuplexSinglePageJobTrueHPSmartDuplexOddPageJobTrueHPJobByJobOverrideJBJOHPManualDuplexDialogItemsInstructionID_01_FACEDOWN-NOROTATEHPPaperSizeDuplexConstraintsSTATEMENTHPMediaTypeDuplexConstraintsEXTRA_HEAVYHPManualFeedOrientationFACEDOWNHPOutputBinOrientationFACEDOWNHPManualDuplexDialogModelModelessHPManualDuplexPageOrderEvenPagesFirstHPMapManualFeedToTray1TrueHPManualDuplexPageRotateDriverRotateHPPrintOnBothSidesManuallyFalseHPStraightPaperPathFalseHPPosterPrintingFalseHPPosterPrintingOptionPOSTER_2HPNUseDiffFirstPageChoiceTRUEHPPageExceptionsFilehpcPE5r1HPPageExceptionsInterfaceShowPageExceptionsHPPageExceptionsLowEndHPPageExceptionsLowEndVerHPPageExceptionsCoverInsertionHPDuplicateJobNameOverrideSWFWHPDocUISUITruePSAlignmentFilehpcLS5r1PSServices_DeviceandSuppliesStatusTRUEHPSmartHub_OnlinediagnostictoolsTRUEHPSmartHub_SupportandtroubleshootingTRUEHPSmartHub_ProductmanualsTRUEHPSmartHub_CheckfordriverupdatesTRUEHPSmartHubInet_SID_263_BID_276_HID_265PSServicesOptionPrnStat_SID_242_BID_270_HID_15521HPDocPropResourceDatahpchl5r1.cabHPConsumerCustomPaperHPCustomJRConstraintsJRCHDPartialJRHDInstalledJRHDOffJRHDNotInstalledJRHDOffHPJobAccWoPinTrueHPXMLFileUsedhpc24205.xmlIUPHxn@'B\BٱHYA vJED\T)Mv@W@<<,y s)HF3gƗf|)P1SCSuXg 8 lib18LF mJ;\ao!hVQG3xrVz:q~=W[ѤG"-qp/N j,i߳COKY0QaCj;#"Ӂ|6qof|؜6,~ ͘^; 0||;f/Gc5eP*ɹˮOR$-<Ή6.6ti]dkԊL%m%3ttc>lpG0-4~g9]΁I{ov'`gَ8myӅ7 n ]óg6/}-FZAAA=/cL_m!`@UnknownGz Times New Roman5Symbol3& z Arial7Tms Rmn?0LinePrinter" V02F02F<< $Vxx4o!o!VHX?fTP2 don.wismerOh+'0l  ( 4 @LT\d Normal.dot don.wismer2Microsoft Office Word@V@w @w ՜.+,0 hp|  <o!  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