An Act To Limit MaineCare Reimbursement for Methadone Treatment

Sec. 1. 22 MRSA §3174-SS  is enacted to read:

§ 3174-SS.  Methadone reimbursement limitations

Effective January 1, 2013, the following limitations apply to reimbursement under the MaineCare program for methadone for the treatment of addiction to opiates as defined in Title 17-A, section 1101, subsection 7. Services must be provided at the clinic located closest to the home of the member and services must be limited to a lifetime maximum of 24 months, except that reimbursement may be provided for longer than 24 months if prior authorization is received from the department.

The department shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

Sec. 2. Review of options. The Department of Health and Human Services shall review the options that the Office of MaineCare Services has under federal law to restrict transportation services reimbursement related to methadone treatment under the MaineCare program to encourage efficient use of transportation services and to discourage and penalize fraud. The review must include a study of laws in other states restricting transportation reimbursement to a certain number of times per week or times per lifetime and must include a study of limitations based on one-way or round-trip reimbursement and a requirement to use the provider whose office is the closest to the MaineCare member's home. The review must provide information on exception and appeals processes and estimated savings for options judged by the Office of MaineCare Services to be viable for the State. The department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters by December 15, 2012 on the department's findings and recommendations as a result of this review.

summary

This bill proposes to limit MaineCare reimbursement for methadone for the treatment of addiction to opiates to a lifetime maximum of 24 months, effective January 1, 2013. The bill authorizes reimbursement for longer than 24 months if the Department of Health and Human Services provides prior authorization. The bill proposes to limit services to the clinic closest to the home of the member. The bill requires the department to review the options to restrict transportation services reimbursement for methadone treatment under the MaineCare program to encourage efficient use of transportation services and to discourage and penalize fraud. The review must include a study of limitations based on one-way or round-trip reimbursement and a requirement to use the provider whose office is the closest to the MaineCare member's home. The department is required to report to the joint standing committee of the Legislature having jurisdiction over health and human services matters by December 15, 2012 on the department's findings and recommendations as a result of the review.