An Act To Ensure Continuity of Care Related to Implementation of the Federal Medicare Drug Benefit
Maine Legislature, Session 122, LD 1325
Committee: Health and Human Services
Sponsors: BRAUTIGAM, PERRY, SMITH, WEBSTER, COWGER, MAYO
Amends: 22 MRSA §254, 22 MRSA §255, 22 MRSA §3174-G

Legislative Document 
No. 1325 
H.P.924 
House of Representatives, March 15,2005 
An Act To Ensure Continuity of Care Related to Implementation of 
the Federal Medicare Drug Benefit 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative BRAUTIGAM of Falmouth. 
If/~ 
m.7i/d£~ 
Mll..LICENT M. MacFARLAND 
Clerk 
Cosponsored by Representatives: PERRY of Calais, SMITH of Monmouth, WEBSTER of 
Freeport, Senators: COWGER of Kennebec, MAYO of Sagadahoc. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-I. 22 MRSA §254. 3rd 1f, as enacted by PL 2001, c. 691, 
§l and affected by §6, is amended to read: 
The commissioner shall make available suitable applications 
wi th instructions for applicants. 
By submitting an application 
or participating in a 
review to redetermine eligibility for 
benefits under this section, the applicant agrees that, if the 
applicant is determined eligible for benefits under this section, 
the 
department 
may 
provide 
assistance 
to 
the 
applicant 
i~ 
securing 
benefits 
under 
Medicare 
D 
and 
may 
serve 
as 
the 
authorized representative of the applicant for the purpose of 
enrollment in any Medicare D plan. 
The department may choose in 
which 
Medicare 
D 
plan, 
options 
or 
coverage 
to 
enroll 
the 
applicant and may choose to apply for any available subsidies on 
behalf of the applicant. The department shall adopt rules that 
describe the circumstances in which an applicant eligible fox 
benefits under this section retains the right to enroll or make 
other choices in connection with Medicare D coverage. 
Sec. A·2. 22 MRSA §254, sub-§I-A, ,0, as enacted by PL 2001, 
c. 691, §l and affected by §6, if amended to read: 
read: 
B. 
An 
individual 
does 
not 
receive 
full 
MaineCare 
pharmaceutical benefits~i 
Sec. A-3. 22 MRSA §254, sub-§I-A, "C and D are enacted to 
c. 
Beginning January 1, 2006, an individual is not eligible 
for Medicare D benefits or the individual is eligible but 
Medicare D does not provide coverage for the drugs needed by 
the individual. 
D. 
An individual is eli~le for Mainecare and ~~icare D. 
With 
regard 
to 
eligibility 
under 
this 
paragraph, 
an 
individual may receive only wrap servic.es as provided in 
subsection 13 and rules adopted by the department; 
Sec. A-4. 22 MRSA §254, sub·§l1-A, as enacted by PL 2001, c. 
691, §1 and affected by §6, is a~ended to read: 
II-A. 
Retention of eligibility. 
A person who was eligible 
for the program at any time 
fro~ August 1, 1998 to July 31, 1999 
and who does not meet the requirements of subsection 10 retains 
eligibility for the program if that person is a 
member of a 
household of an eligible person; ana 
Page l-LRI609(1) 
, 
Sec. A-5. 22 MRSA §254, sub-§12, as enacted by PL 1999, c. 
731, Pt. TT, §10, is amended to ~ead: 
12. 
Funds 
General Fund to 
not to lapse. 
Funds 
appropriated 
from 
the 
carry out the purpose of this section may not 
lapse but must carry from year to yearTL 
Sec. A-6. 22 MRSA §254, sub-§§13 to 15 are enacted to read: 
13. 
Wrap 
seryi~es. 
The 
department 
shall 
adopt 
rules 
qoverning wrap serv~_ to provide coverage under the program~ 
individuals who are eligible for prescription drug benefits under 
both 
MaineCare 
and 
Medicare 
D. 
For 
the 
purposes 
of 
th~ 
subsection 
"wrap 
services" 
means 
coverage 
for 
certain 
prescription and nonprescription drugs that are needed by an 
individual and that are not available under MaineCare or Medicare 
.!LL 
14. 
C~~uit,y of care. 
The department shall adopt rules 
governing cont_inuity of care under the program to ensure 
th~-.t. 
individuals who are eligible for prescription and nonprescription 
drug benefits under Medicare D and the program or under Med~ 
D, 
the program and MaineCare do not lose coverage for needed 
~r~S at the be9i~ng of coyera~nder Medicare D, as a 
r~lt 
of the required copayment in 'Medicare D after the amount of 
.i~ial coverage or by 
oper~ion of law or regulation or ryJe 
applicable to the program, the MaineCare program or Medicare D; 
.and 
.1.5. 
Edu~tion aAd outreach. 
The department shall provide 
education and outreach services to applicants and 
individua~ 
enrolled in the program to increase access to needed prescription 
and nonprescription drugs and fully use other private, state and 
federal progr~ns. 
I. 
Sec. A-7. 22 MRSA §254, as amended by PL 2003, c. 611, §l and 
c. 689, Pt. B, §6, is further amended by adding at the end a new 
paragraph to read: 
Rules adopted purs~~ this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. A-S. 
Transitional prescription and nonprescription drug 
benefits. 
Beginning November 1, 2005, and continuing until such 
time as individuals who are enrolled in both the elderly low-cost 
drug program pursuant to the Maine Revised Statutes, Title 22, 
section 
254, 
and 
Medicare 
j) 
are 
able 
to 
obtain 
needed 
prescription and nonprescription drugs covered under Medicare D 
without undue hardship or until April 1, 2006, whichever occurs 
first, the Department of Health and Human Services shall provide 
transitional prescription and nonprescription drug benefits under 
the elderly low-cost drug program to persons who are enrolled in 
the elderly low-cost drug program and who may be eligible for 
Medicare 
D or who 
are enrolled in Medicare 
D. 
Transitional 
prescription and nonprescription drug benefits under this section 
must include filling and refilling prescriptions for longer than 
the usual time periods, allowing the refilling of prescriptions 
prior to the usual date in order to provide continuity of care 
between 
programs 
and 
such other benefits 
as 
the 
department 
determines to be necessary to ensure that persons enrolled in the 
elderly low-cost drug program and Medicare D do not experience a 
lapse in coverage due to the transition to Medicare D. 
Sec. A-9. Retention of funding for state fiscal years 2004-05, 2005-06 
and 2006-07. 
Notwithstanding any other provision of law, in order 
to ensure the continuity of care for Maine's elderly and disabled 
persons during the transition to drug benefits under Medicare D, 
funds allocated or appropriated to the elderly low-cost drug 
program under the Maine Revised Statutes, Tit'le 22, section 254 
during state fiscal years 2004-05, 
2005-06 and 2006-07 do not 
lapse and may be transferred to another account or used for 
another 
purpose 
only 
after 
a 
vote 
of 
deappropriation 
or 
deal location by the Legislature. 
I 
PARTB 
Sec. B·l. 22 MRSA §255.A is enacted to read: 
S255-A. 
Coordination of prescription and nonprescription 
drug benefits 
Beginning NQYIDDb~-<~.oQ5, the de],lQ£tmen~hall coordi_njOj,te 
the drug benefits of persons who are eligible for prescription 
and 
nonprescription 
drugs 
uIMier 
any 
of 
the 
drug 
beneLit 
programs covered by this se~n in order to i,ilcrease access tQ 
needed prescription and nonprescription drugs at affordable costs. 
1. 
Definitions~L. __ ~A~s __ ~u~s~e~dL-~i~n~_t~h~i~s __ ~s~e~cutdi~o~n~'L-_u~n~IEe£s£s __ ~th~ 
~Qn~e",x~J;.berwise 
indi~, the 
following 
t~ms have 
the 
following meanings. 
A. 
"Drug benefit program" means Medicare D, 
the elderly 
low-cost drug program or MaineCare. 
B. 
"Elder_U: __ 
lID!~J;. ___ dru9--l?_t:_Qgram" 
means 
the 
elder ly 
low-cost drug program under section 254. 
, 
: 
C. 
"Main~are" means the MaineCare program under 
chap~ 
~ 
D. 
"Megicare 
0" 
m!iHm~~art 0 
of the federal 
Megicare 
Prescription 
Drug~~.~p~r~o~v~e~m~e~n~tu,~~a~n~d~~M~o~d~eir~n~i~z~a~t~i~o~n~~A~c~t~~o~f 
~ 
~_. 
_J::_QQ..~<li!l8t.iQ.p.. 
The 
dep~rtrrt@~ha.ll 
cO~.ip.ate 
the. 
benefits 
of 
persons 
who 
are 
eligible 
for 
prescription 
and 
nonpre~ription drug 
~e.J_il~-.l.ffic;1~edicare 0 and the elderly 
low-cost drug program or the MaineCare program or both. 
In 
'<;Q.Q~.din.Qting benefits the department shall perform the follow.i,ng 
functions: 
A. 
Provid~shtj~l,nGe._iu. applying for Medicare 
under 
section 254, 3rg paragraph and section 3174-GG: 
B. 
Provide wrap 
~ervices under section 254, subsection 13 
2nd section 3174-GG: 
C. 
Proyi..Q,~J;_in.J.li.tt-9J;:_ care under section 254, subsection 
and section 3174-GG: and 
D. 
Provide 
education 
and 
outreach 
under 
section 
254, 
subsection 15 and section 3174-GG. 
3. 
Rulem.a..tipg. 
The 
department 
shall 
adopt 
implement 
this 
section. 
Rules 
adopted 
pursuant 
.§ubsection are routine technical rules as defined in 
chapter 375, subchapter 2-A. 
PARTC 
Sec. C-1. 22 MRSA §3174-GG is enacted to read: 
'1 
§3114-GG. 
Coordination of prescription drug benefits 
rules 
to 
to 
this 
Title 5, 
Beginning November 1, 2005, 
th~~rtment shall coordinate 
tb~!ll:JJ.9_~ne..ti..~Lpe.L~_Qn~..Jim_:r.9~_.i,n the M..a..i.p..e...c.a.~~9.I.am_Q& 
provided 
in 
section 
2S5-A 
to 
increase 
access 
to 
needed 
prescription and nonprescription drugs at affordable costs. 
PARTD 
Sec. D-1. Rulemaking for nursing facility services. 
By January 1, 
2006, 
the 
Department 
of 
Health 
and 
Human 
Services 
shall amend the rules regarding the principles of reimbursement 
for 
nursing facilities 
to 
increase 
the 
amount 
that 
may 
be 
retained by a resident of a facility. 
The rules must allow the 
retention of $40 per month plus the amount required to be paid by 
the 
resident 
for 
copayments 
for 
needed 
prescription 
and 
nonprescription 
drugs 
under 
the 
following 
drug 
programs, 
as 
applicable to the resident: the elderly low-cost drug program 
under 
the 
Maine 
Revised 
Statutes, 
Title 
22, 
section 
254, 
subsection 4-A, 
the 
MaineCare 
program pursuant to Title 
22, 
chapter 
and 
Medicare 
D 
under 
the 
federal 
Medicare 
Prescription Drug, 
Improvement, 
and Modernization Act of 2003. 
Rules 
adopted pursuant to this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. D·2. 
Rulemaking for residential care 
~nd assisted living 
services. 
By January 1, 2006, the Department of Health and Human 
Services 
shall 
amend 
the 
rules 
regarding 
the 
principles 
of 
reimbursement for residential care and assisted living facilities 
to increase the amount that may be retained by a resident of a 
facility. 
The rules must allow the retention of the same amount 
per month that could be retained on July 1, 2005 plus the amount 
required to be paid by the resident for copayments for needed 
prescription and nonprescription drugs under the following drug 
programs, 
as applicable to the resident: the elderly low-cost 
drug program under the Maine Revised Statutes, Title 22, section 
254, subsection 4-A, the MaineCare program pursuant to Title 22, 
chapter 
and 
Medicare 
D 
under 
the 
federal 
Medicare 
Prescription Drug, 
Improvement, 
and Modernization Act of 2003. 
Rules 
adopted pursuant to this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A. 
SUMMARY 
This 
bill 
provides 
for 
implementation of the Medicare 
follows. 
continuity 
of 
care 
D prescription drug 
related 
benefit 
to 
as 
1. 
The bill authorizes the Department of Health and Human 
Services 
to 
provide 
assistance 
to 
persons 
applying 
[or 
and 
enrolled in the elderly low-cost drug program so that they may 
obtain benefits under Medicare D. 
2. 
The bill allows coverage under the elderly low-cost drug 
program 
for 
persons 
enrolled 
in 
Medicare 
D 
under 
certain 
circumstances. 
3. 
The bill provides for wrap services, continui ty of care 
and education and outreach in thp- elderly low-cost drug program. 
4. 
The bill directs the Department of Health and Human 
Services to adopt routine technical rules for the provisions of 
the bill in the elderly low-cost drug program. 
5. 
The bill directs the Department of Health and Human 
Services to provide transitional prescription and nonprescription 
drug benefits under the elderly low-cost drug program for persons 
enrolled in the program who may be eligible for or are enrolled 
in Medicare D. 
6. 
The bill retains funding appropriated in the elderly 
low-cost drug program for state fiscal years 2004-05, 2005-06 and 
2006-07. 
7. 
The bill requires the Department of Health and Human 
Services to coordinate benefits among the elderly low-cost drug 
program, 
the 
MaineCare 
program 
and 
Medicare 
D 
in order 
to 
increase access to needed prescription and nonprescription drugs 
at affordable costs. 
8. 
The bill directs the Department of Health and Human 
Services to amend the rules regarding the amount of income that 
may be retained by a resident of a nursing, residential care or 
assisted living facility to allow an increase to cover the cost 
of 
the 
person's 
copayment 
for 
needed 
prescription 
and 
nonprescription drugs under the elderly low-cost drug program, 
the MaineCare program and Medicare D.