An Act to Make Supplemental Appropriations and Allocations for the Expenditures of State Government and to Change Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2004 and June 30, 2005 LR2833(24)
Maine Legislature, Session 121, LD 1919
Committee Amendment CA_A-HA_K_H924 (House)
Amends: 22 MRSA §3174-F

HOUSE 
AMENDMENT "J(" to COMMITTEE 
AMENDMENT 
"A" to H. P • 
1420, 
L.D. 
1919, 
Bill, 
"An 
Act 
To 
Make 
Supplemental 
Appropriations 
and Allocations for the Expenditures of State 
Government and To Change Certain Provisions of the Law Necessary 
to the Proper Operations of State Government for the Fiscal Years 
Ending June 30, 2004 and June 30, 2005" 
Amend the amendment by striking out all of part MMM 
and 
inserting in its place the following: 
'PARTMMM 
Sec. MMM-l. 22 MRSA §3174-FF is enacted to read: 
§3l74-FF. 
MaineCare Basic 
1. 
Established. 
The MaineCare Basic program is established 
to deliver medically necessary health care services to adult 
members of the MaineCare program. 
2. 
Rules. 
The department shall adopt rules to implement 
MaineCare Basic in accordance with this section. 
Rules adopted 
pursuant to this section are routine technical rules as defined 
in Title 5, chapter 375, subchapter 2-A. 
3. 
Services. 
The rules adopted pursuant to subsection 2 
must 
provide 
for 
access 
to medically necessary services 
as 
provided in the federally approved Medicaid state plan. 
Benefits 
for certain services are limited as follows. 
A. 
A member is eligible for speech therapy benefits if the 
member has been assessed to have rehabilitation potential 
and has been documented by a physician to have experienced a 
significant decline in ability to communicate orally, safely 
swallow or masticate. 
Speech therapy benefits must cover 
HOUSE AMENDMENT 
,~~. 
~ 
.. ~ 
. 
HOUSE 
AMENDMENT "K" to COMMITTEE 
AMENDMENT 
"A" to H. P • 
L.D. 1919 
1420, 
one initial evaluation of the member per provider per year 
and one reevaluation every 6 months per provider. 
Speech 
therapy benefits must cover outpatient therapy provided in 
the home, independent practitioners' offices and speech and 
hearing clinic sites. 
B. 
A member is eligible for psychological services benefits 
for individual and group counseling. 
Benefits for one or 
both types of counseling combined are limited to a total of 
one-hour visits per year. 
C. 
A member is eligible for benefits for durable medical 
eguipment, prosthetics and orthotics for one pair of shoes 
and one pair of inserts per year, medical supplies reguired 
to meet standard daily needs and power wheelchairs for a 
member 
who 
is 
nonambulatory 
and 
has 
a 
significant 
neuromuscular disease or disorder. 
D. 
A 
member is eligible for occupational 
and physical 
therapy 
benefits 
provided 
by 
occupational 
and 
physical 
therapists licensed under Title 32 and who are acting within 
their 
scope 
of practice. 
Services 
of occupational 
and 
physical 
therapists 
may 
be 
provided 
in all outpatient 
settings, including the home. 
For services subject to this 
paragraph, the department may reguire a member to have that 
member's rehabilitation potential documented by a physician 
and may limit treatment to: 
(1) 
Treatment following an acute hospital stay for a 
condition affecting range of motion, muscle strength 
and physical functional abilities; 
(2) 
Treatment after a surgical procedure performed for 
the purpose of improving physical function; or 
(3) 
Treatment in those situations in which a physician 
has documented that the patient has in the preceding 30 
days reguired extensive assistance in the performance 
of one or more of the following activities of daily 
living: eating, toileting, locomotion, transfer or bed 
mobility. 
The department may limit occupational and physical therapy 
services benefits under this paragraph for palliative care 
and maintenance of function to one visit per year to design 
a plan of care and train the member or caretaker of the 
member to implement the plan or to reassess the plan of care. 
E. 
A member is eligible for benefits for 
chiropractic 
services provided by a 
chiropractor licensed under Title 
HOUSE AMENDMENT 
~.~. 
'1.~"¢ 
~,~~ 
HOUSE AMENDMENT "!<." to COMMITTEE 
AMENDMENT "A" to H.P. 1420, 
L.D. 1919 
32. 
Benefits under this paragraph may be limited by the 
department by requiring 
a 
member 
to have that member's 
rehabilitation 
potential 
documented 
by 
a 
physician. 
Benefits may be limited to treatment as follows: 
(1) 
Treatment 
for 
acute 
neuromuscular 
skeletal 
conditions affecting range of motion. muscle strength 
and physical functional abilities: or 
(2) Treatment after a surgical procedure performed for 
the purpose of improving physical function. 
F. 
A member is eligible for benefits under the private duty 
nursing and personal care program and waiver programs for 
the physically disabled or elderly as long as those benefits 
may be limited by reductions in units of service or by rate 
reductions. 
G. 
A member who is eligible for benefits under section 
3l74-G. subsection 1. paragraph F is eligible for benefits 
under this section subject to the provisions of paragraphs A 
to G and to additional rules limiting benefits as specified 
in this paragraph. 
(1) 
Benefits for inpatient hospital admissions 
are 
limited to 2 per year. except that more admissions may 
be 
approved 
through 
prior 
authorization 
by 
the 
department. 
This subparagraph does not limit inpatient 
hospital 
benefits 
for 
laboratory 
services. 
x-ray 
services, prenatal care and mental health diagnoses. 
(2) 
Benefits for outpatient visits to a hospital are 
limited to 5 per year. except that more visits may be 
approved 
through 
prior 
authorization 
by 
the 
department. 
This subparagraph does not limit benefits 
for visits for laboratory services. 
x-ray services. 
prenatal care and mental health diagnoses. 
(3) 
Benefits for brand-name prescription medications 
are limited to 5 medications dispensed during the same 
time 
period. 
except 
that 
benefits 
for 
additional 
brand-name medications may be approved through prior 
authorization by the department. 
In addition to the 
brand-name limitation. as compared to members who are 
eligible under 
other paragraphs 
of 
section 
3l74-G. 
subsection 
I. 
prescription 
medication 
benefits 
for 
members who are eligible under paragraph F are limited 
by stricter prior authorization requirements. increased 
review of 
pharmacy 
use 
and 
a 
request 
for 
federal 
permission to waive freedom of choice. 
HOUSE AMENDMENT 
~~, 
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HOUSE AMENDMENT "K" to COMMITTEE 
AMENDMENT "A" to H.P. 1420, 
L.D. 1919 
( 4) 
A 
member 
who 
is eligible for 
benefits 
under 
section 
3l74-G, 
subsection 
L 
paragraph 
F 
begins 
coverage on the date that the department determines 
that the member is eligible. 
Sec. MMM·2. Service limitation or rate reduction. 
Home Based 
Care Program benefits administered by the Department of Human 
Services may be limited by reductions in units of service or by 
rate reductions for fiscal year 2004-05 in order to achieve 
savings of $466,666 in General Fund expenditures in the program 
budget. 
Sec. 
MMM·3. 
Savings 
in 
MaineCare 
expenditures. 
The 
Department of Human 
Services is authorized to adopt routine 
technical rules in the MaineCare program in accordance with Title 
22, section 3l74-FF to achieve savings for the General Fund in 
the following amounts in fiscal year 2004-05: speech therapy, 
occupational 
therapy 
and 
physical 
therapy, 
$297,714; 
chiropractic, 
$80,873; 
durable 
medical 
equipment, 
$350,000; 
prosthetics 
and 
orthotics, 
$43,094; 
psychological 
services, 
$125,740; private duty nursing and waiver programs for persons 
who are elderly or disabled, $233,333; noncategorical members' 
inpatient 
care, 
$482,374; 
noncategorical 
members' 
outpatient 
care, $945,841; noncategorical members' prescription medications, 
$200,000; 
and noncategorical members' 
prospective eligibility, 
$560,859. 
Sec. MMM·4. Appropriations and allocations. 
appropriations and allocations are made. 
BOMAJ.f SERVICES, DEPARTMENT OF 
Long-term Care -
Human Services 
0420 
The 
following 
Initiative: 
Deappropriates funds for home-based care program 
benefits administered by the Department of Human Services to 
reflect program limits to be achieved by reductions in units of 
services or by rate reductions. 
General Fund 
All Other 
General Fund Total 
Bureau of Medical Services 
0129 
2003-04 
$0 
$0 
2004-05 
($466,666) 
($466,666) 
Initiative: 
Appropriates 
and 
allocates 
funds 
for 
contractual 
services to implement changes in the MaineCare benefit package, 
establishment 
of 
medical 
criteria, 
performance 
of 
medical 
HOUSE AMENDMENT 
,,~~~:fi~' 
HOUSE 
AMENDMENT "K" to COMMITTEE 
AMENDMENT 
"A" to H.P. 1420, 
L.D. 1919 
assessment 
activities, 
utilization 
review, 
authorization and medical management. 
increased 
prior 
General Fund 
All Other 
General Fund Total 
Federal Expenditures Fund 
All Other 
Federal Expenditures Fund Total 
Medical Care -
Payments to Providers 
0147 
2003-04 
2004-05 
$0 
$1,000,000 
$0 
$1,000,000 
2003-04 
2004-05 
$0 
$1,000,000 
$0 
$1,000,000 
Initiative: Deappropriates and deallocates 
funds 
to 
implement 
MaineCare Basic for all adults. 
General Fund 
All Other 
General Fund Total 
Federal Expenditures Fund 
All Other 
Federal Expenditures Fund Total 
Medical Care -
Payments to Providers 
0147 
2003-04 
$0 
$0 
2003-04 
$0 
$0 
2004-05 
($8,129,086) 
($8,129,086) 
2004-05 
($15,210,237) 
($15,210,237) 
Initiative: Deappropriates and deallocates funds 
to 
implement 
MaineCare Basic for childless adults. 
General Fund 
All Other 
General Fund Total 
Federal Expenditures Fund 
All Other 
Federal Expenditures Fund Total 
HUMAN SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
DEPARTMENT TOTAL -
ALL FUNDS 
2003-04 
$0 
$0 
2003-04 
$0 
$0 
2003-04 
$0 
$0 
2004-05 
($1,989,074) 
($1,989,074) 
2004-05 
($3,721,732) 
($3,721,732) 
2004-05 
($9,584,826) 
(17,93l,969) 
($27,516, 795)' 
HOUSE AMENDMENT 
"'~' 
0:,:~;:"'~ 
,,~ w 
HOUSE 
AMENDMENT "K " to COMMITTEE 
AMENDMENT 
"A" to H. P . 
20, 
L.D. 1919 
Further amend the amendment by adding at the end before the 
emergency clause the following: 
'PARTFFFF 
Sec. FFFF·l. Appropriations and allocations. 
appropriations and allocations are made. 
DUMAN SERVICES, DEPARTMENT OF 
Medical Care -
Payments to Providers 
0147 
The 
following 
Initiative: 
Provides funds for rehabilitation services benefits 
for brain injury. 
General Fund 
All Other 
General Fund Total 
Federal Expenditures Fund 
All Other 
Federal Expenditures Fund Total 
DUMAN SERVICES, DEPARTMENT OF 
DEPAR"l'MENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FORD 
DEPARTMENT "l'O'l:AL -
ALL FORDS 
Further amend 
any 
nonconsecutive 
consecutively. 
the amendment by 
Part 
letter 
or 
SUMMARY 
2003-04 
2004-05 
$0 
$1,500,000 
$0 
$1,500,000 
2003-04 
2004-05 
$0 
$2,806,632 
$0 
$2,806,632 
2003-04 
2004-05 
$0 
$1,500,000 
2,806,632 
$0 
$4,306,632' 
relettering or renumbering 
section 
number 
to 
read 
This amendment strikes the language that requires Maine Care 
Basic 
to 
provide 
rehabilitation services benefits 
for 
brain 
HOUSE AMENDMENT 
HOUSE 
AMENDMENT "~I to COMMITTEE 
AMENDMENT "A" to H.P. 1420, 
L.D. 1919 
injury. 
The 
amendment 
also 
appropriates 
rehabilitation services for brain injury. 
SPONSORED BY'('\~ \1~y.:J 
(Representa~e TWOMEY) 
U 
TOWN: 
Biddeford 
fISCAL :\OTE REQClRED 
(See .attached) 
$1,500,000 
HOUSE AMENDMENT 
for 
Net Cost (Savings) 
General Fund 
Appropriationsl Allocations 
General Fund 
Federal Expenditures Fund 
Revenue 
Federal Expenditures Fund 
Fiscal Detail and Notes 
Approved: 04/14/04 ~ae 
Office of Fiscal and Program Review 
LD 1919 
An Act to Make Supplemental Appropriations and Allocations for the 
Expenditures of State Government and to Change Certain Provisions of 
the Law Necessary to the Proper Operations of State Government for the 
Fiscal Years Ending June 30, 2004 and June 30, 2005 
LR2833(24) 
Fiscal Note for House Amendment" " to Committee Amendment" A" 
Sponsor: Rep. Twomey 
Fiscal Note Required: Yes 
Fiscal Note 
2003-04 
2004-05 
$0 
$1,500,000 
$0 
$1,500,000 
$0 
$2,806,632 
$0 
$2,806,632 
This amendment will increase the General Fund cost of the bill by $1,500,000 in fiscal year 2004-05. Based on the 
estimated year-end balances, a balanced budget is not maintained for the 2004-2005 biennium. 
LR2833(24) - Fiscal Note - Page 1 of 1