HP1092, LD 1485, item 1, An Act To Promote Transparency in the Medicaid Reimbursement Process

An Act To Promote Transparency in the Medicaid Reimbursement Process

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA c. 603, sub-c. 1-B is enacted to read:

SUBCHAPTER 1-B

MAXIMUM ALLOWABLE COST LIST

§ 2687. Maximum allowable cost list

1. Comment period. The Department of Health and Human Services, office of MaineCare services shall establish a 60-day written comment period on any proposed change to the state maximum allowable cost list if the change results in a reduction in payment to pharmacies. The comment period may not occur more than quarterly. The written comment period must be held in compliance with the Maine Administrative Procedure Act. A change in the maximum allowable cost list that will result in a reduction in payment to pharmacies may not take effect until 90 days after the office of MaineCare services has completed its response to any written comments. For the purposes of this section, "maximum allowable cost list" means a list of prescription drugs that bases reimbursement on the cost of the generic product.

2. Report. The Department of Health and Human Services, office of MaineCare services shall prepare an annual report that summarizes the number of drugs affected by changes made to the maximum allowable cost list under subsection 1 and the percentage change in payment for those drugs that resulted from changes to the list during the calendar year. The office of MaineCare services shall file the report annually by December 31st with the joint standing committee of the Legislature having jurisdiction over health and human services matters.

3. Rulemaking. The Department of Health and Human Services, office of MaineCare services shall amend its rules to implement the provisions of this subchapter. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

SUMMARY

This bill requires the Department of Health and Human Services, office of MaineCare services to establish a 60-day written comment period on any proposed change to the state maximum allowable cost list if the change results in a reduction in payment to pharmacies. The office of MaineCare services is required to prepare an annual report that summarizes the number of drugs affected by such changes and the percentage change in payment for those drugs that resulted from changes to the list during the calendar year and submit that report annually by December 31st to the joint standing committee of the Legislature having jurisdiction over health and human services matters. The Department of Health and Human Services, office of MaineCare services is required to amend its rules to implement the provisions of this bill.

HP1092 LD 1485	First Regular Session - 125th Maine Legislature		LR 2085 Item 1
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