Resolve, Directing the Department of Health and Human Services To Review Rules Governing Reimbursement to MaineCare Recipients for Transportation to Freestanding Methadone Clinics

Sec. 1. Definitions. Resolved: That, as used in this resolve, unless the context otherwise indicates, the following terms have the following meanings:

1. "Client" means a MaineCare recipient who receives treatment at a clinic;

2. "Clinic" means a freestanding methadone clinic within the State; and

3. "Community agency" means a community agency that provides transportation services for clients to clinics; and be it further

Sec. 2. Review; rules. Resolved: That the Department of Health and Human Services shall review reimbursement to clients for transportation to clinics and shall adopt rules to ensure uniformity in reimbursement throughout the State and to reduce the incidence of fraud. The department shall solicit input from community agencies throughout the State regarding the protocols used by the various agencies to schedule and verify appointments to clinics. The department shall also solicit input from district attorneys within the State regarding any instances of fraud in such reimbursement. Rules adopted pursuant to this section must include the following requirements:

1. In order to receive reimbursement for transportation to a clinic, a client must contact a community agency prior to the date of the scheduled appointment at the clinic and state that the client cannot afford to keep the appointment unless the client receives reimbursement;

2. Prior to providing transportation services, a community agency shall confirm the client's eligibility for MaineCare benefits. The department shall facilitate such confirmation by authorizing access by community agencies to MaineCare eligibility databases;

3. The client shall provide written confirmation of the client's current address at the time of the scheduled appointment;

4. The client shall file a form after each trip documenting mileage and tolls and the community agency shall confirm that mileage and tolls are reasonable;

5. A clinic shall require that a client seeking travel reimbursement sign in at the time of the provision of clinic services. The clinic shall share its appointment schedule for that client with the community agency;

6. A clinic shall deploy a video surveillance system sufficient to identify the drivers and occupants of all vehicles arriving at the clinic. Clinic staff shall confirm that a client requesting transportation reimbursement arrived in a vehicle at the appropriate time; and

7. If a client is found to have filed a false claim for reimbursement for transportation to a clinic, the clinic shall suspend approving transportation reimbursement for that client. The clinic shall report the fraud to the community agency and the community agency shall report the fraud to the department.

Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A; and be it further

Sec. 3. Report. Resolved: That the Department of Health and Human Services shall submit a report on its review and rules adopted pursuant to section 2 to the joint standing committee of the Legislature having jurisdiction over health and human services matters by December 15, 2012.

summary

This resolve directs the Department of Health and Human Services to review reimbursement to MaineCare recipients for transportation to freestanding methadone clinics and to adopt rules to ensure uniformity in reimbursement throughout the State and reduce the incidence of fraud. The department is directed to submit a report to the joint standing committee of the Legislature having jurisdiction over health and human services matters by December 15, 2012.