Resolve, To Ensure the Coordination and Effectiveness in the Provision of Outpatient and Medication Management Services under Maine's Noncategorical Waiver
Maine Legislature, Session 122, LD 1701
Committee Amendment CA_A_H964 (House)

COMMITTEE AMENDMENT A" to H.P. 1208, L.D. 1701, "Resolve, To Ensure 
the Coordination and Effectiveness in the Provision of Outpatient and Medication 
Management Services under Maine's Noncategorical Waiver" 
Amend the resolve by striking out the title and substituting the following: 
'Resolve, To Ensure Coordination and Effectiveness in the Provision of 
Services under the MaineCare Noncategorical Waiver' 
Further amend the resolve by striking out everything after the title and before the 
summary and inserting in its place the following: 
'Sec. 1. Development of processes. Resolved: That the Department of Health 
and Human Services shall ensure the coordination and effective provision of MaineCare 
services provided to noncategorical members eligible for benefits under the Maine 
Revised Statutes, Title 22, section 3174-G, subsection 1, paragraph F, referred to in this 
section as "noncategorical members," by: 
1. 
Implementing a process for tracking the number of mental health treatment 
sessions provided to noncategorical members for purposes of appropriate clinical 
planning; 
2. Establishing and implementing prior authorization processes to aid in ensuring 
that a noncategorical member's remaining service availability is not exhausted within any 
given calendar year; 
3. Creating criteria for necessary clinical justification for exceeding the calendar year 
limit of outpatient services. The department may increase the maximum number of visits 
for outpatient mental health services, excluding visits for medication management, to 24 
visits in a 12-month period as long as any cost associated with this increase is offset by 
savings from managing the utilization of this service by methods that may include prior 
authorization; 
4. Developing systems to enable providers to identify the eligibility category of 
noncategorical members, the members' enrollment dates and the members' recertification 
dates; 
COMMITTEE AMENDMENT 
~. · 
",. 
COMMITTEE AMENDMENT fJ" to H.P. 1208, L.D. 1701 
5. Developing systems for transition planning for noncategorical members who leave 
or become ineligible for the MaineCare program; and 
6. Providing a priority reinstatement process for certain noncategorical members 
who have good cause for failing to recertify their eligibility or placement on the waiting 
list in a timely manner. 
The department may adopt routine technical rules, as defined in Title 5, chapter 375, 
subchapter 2-A, as needed to implement this section. ' 
SUMMARY 
This amendment changes the title of the resolve. It retains the provisions of the 
resolve for tracking the number of mental health treatment sessions, establishing prior 
authorization processes and creating criteria for clinical justification for exceeding the 
calendar year limit. It creates a cap of up to 24 visits for outpatient services excluding 
visits for medication management, provided that any cost increase is offset by savings 
from managing utilization through prior authorization. It directs the Department of 
Health and Human Services to develop systems that enable providers to identify the 
eligibility category of noncategorical members, the members' enrollment dates and the 
members' recertification dates. The amendment also requires the department to develop 
systems for transition planning for noncategorical members who for any reason leave the 
MaineCare program. Additionally, the amendment directs the department to provide a 
priority reinstatement process for certain noncategorical members. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 03/30106 frac 
LD 1701 
LR 2896(02) 
Resolve, To Ensure the Coordination and Effectiveness in the Provision of Outpatient and Medication 
Management Services under Maine's Noncategorical Waiver 
Fiscal Note for Bill as Amended by Committee Amendment'~" 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Fiscal Detail and Notes 
Assumes any additional costs to the Department of Health and Human Services in implementing this bill can be 
absorbed by the department utilizing existing budgetary resources. Further assumes any increase in the annual cap on 
the number of outpatient services visits from 16 to 24 visits would only be implemented in conjunction with measures 
provided in the bill to offset the cost of the increase and thereby result in no net increase in costs to the MaineCare 
non-categorical waiver program. 
LR2896(2) - Fiscal Note - Page I of 1