Bill Summary – FastDemocracy

APPROVED                 CHAPTER
                                                                MARCH 14, 2024                 546
                                                                BY GOVERNOR              PUBLIC LAW
                                  STATE OF MAINE
                                           _____
                           IN THE YEAR OF OUR LORD
                       TWO THOUSAND TWENTY-FOUR
                                           _____
                                 H.P. 1377 - L.D. 2153
                    An Act to Clarify MaineCare Copayments
Be it enacted by the People of the State of Maine as follows:
    Sec. 1. 22 MRSA §3173-C, sub-§2, as amended by PL 2011, c. 458, §1 and
affected by §4, is further amended to read:
     2. Prescription drug services. Except as provided in this subsection and subsections
3 and 4, a pharmacy shall charge a MaineCare member $3.00 for each drug prescription
that is an approved MaineCare service. The department shall adopt and follow procedures
to ensure compliance with the requirements of 42 United States Code, Section 1396o‑1. A
pharmacy that has followed the procedures adopted by the department to ensure
compliance with the requirements of 42 United States Code, Section 1396o‑1 may refuse
to dispense the drug if the copayment is not paid. Copayments must be capped at $30 per
month per member. Total copayments must be capped per member per month at no more
than the dollar amount equivalent to 10 times the copayment amount. If a member is
prescribed a drug in a quantity specifically intended by the provider or pharmacist, for the
recipient's health and welfare, to last less than one month, only one payment for that drug
for that month is may be required.
    Sec. 2. 22 MRSA §3173-C, sub-§3, ¶F, as amended by PL 2023, c. 405, Pt. A,
§61, is repealed.
    Sec. 3. 22 MRSA §3173-C, sub-§3, ¶G, as enacted by PL 1983, c. 240, is amended
to read:
    G. Any other service or services required to be exempt under the provisions of the
    United States Social Security Act, Title XIX and successors to it.;
    Sec. 4. 22 MRSA §3173-C, sub-§3, ¶H is enacted to read:
    H. Primary care services; and
    Sec. 5. 22 MRSA §3173-C, sub-§3, ¶I is enacted to read:
    I. Community-based behavioral health services.
    Sec. 6. 22 MRSA §3173-C, sub-§7, as amended by PL 2017, c. 407, Pt. A, §76, is
further amended to read:
                                    Page 1 - 131LR2693(03)
    7. Copayments. Notwithstanding any other provision of law, the following
copayments per service per day are imposed and reimbursements are reduced, or both, to
the following levels: The department shall consider, in any reduction in reimbursement to
providers or imposition of copayments, the need to maintain provider participation in the
Medicaid program to the extent required by 42 United States Code, Section
1396a(a)(30)(A) or any successor provision of law.
The department shall maintain copayments on the following services that are nominal in
amount and that may contain exclusions per service category:
    A. Outpatient hospital services, $3;
    B. Home health services, $3;
    C. Durable medical equipment services, $3;
    D. Private duty nursing and personal care services, $5 per month;
    E. Ambulance services, $3;
    F. Physical therapy services, $2;
    G. Occupational therapy services, $2;
    H. Speech therapy services, $2;
    I. Podiatry services, $2;
    J. Psychologist services, $2;
    K. Chiropractic services, $2;
    L. Laboratory and x-ray services, $1;
    M. Optical services, $2;
    N. Optometric services, $3;
    O. Mental health clinic services, $2;
    P. Substance use disorder services, $2;
    Q. Hospital inpatient services, $3 per patient day; and
    R. Federally qualified health center services, $3 per patient day, effective July 1, 2004;
    and
    S. Rural health center services, $3 per patient day.
    T. Prescription drug services.
The department may adopt rules to adjust the copayments set forth in this subsection. The
rules may adjust amounts to ensure that copayments are deemed nominal in amount and
may include monthly limits or exclusions per service category. The need to maintain
provider participation in the Medicaid program to the extent required by 42 United States
Code, Section 1396a(a)(30)(A) or any successor provision of law must be considered in
any reduction in reimbursement to providers or imposition of copayments.
    Sec. 7. 22 MRSA §3173-C, sub-§8, as enacted by PL 2011, c. 458, §2 and affected
by §4, is amended to read:
                                     Page 2 - 131LR2693(03)
    8. Notification. The department shall notify each MaineCare member who is subject
to the copayment requirement in subsection 2 of the copayment requirements, any
exemptions and limitations prior to coding the member's information for required
copayments and shall notify the member again during annual recertification of eligibility.
The department shall publish a list of all copayments and amounts by service category on
the department's publicly accessible website.
                                  Page 3 - 131LR2693(03)
Statutes affected: 
Bill Text LD 2153, HP 1377: 22.3173
Bill Text ACTPUB , Chapter 546: 22.3173