An Act To Promote Healthy Practices for MaineCare Members
Maine Legislature, Session 123, LD 1146
Committee: Health and Human Services
Sponsors: MILLS, MARTIN, FISCHER, MILLETT, PATRICK, TURNER
Amends: 22 MRSA §3173-C

Legislative Document 
No. 1146 
H.P.839 
House of Representatives, March 7,2007 
An Act To Promote Healthy Practices for MaineCare Members 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative MILLS of Farmington. 
Cosponsored by Senator MARTIN of Aroostook and 
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MILLICENT M. MacFARLAND 
Clerk 
Representatives: FISCHER of Presque Isle, MILLETT of Waterford, PATRICK of Rumford, 
Senator: TURNER of Cumberland. 
Printed on recyc led paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §3173-C, sub-§7, as amended by PL 2003, c. 451, Pt. H, §1 
and affected by §3, is further amended to read: 
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: 
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. 
G. 
H. 
I. 
J. 
K. 
L. 
M. 
N. 
O. 
P. 
Physical therapy services, $2; 
Occupational therapy services, $2; 
Speech therapy services, $2; 
Podiatry services, $2; 
Psychologist services, $2; 
Chiropractic services, $2; 
Laboratory and x-ray services, $1; 
Optical services, $2; 
Optometric services, $3; 
Mental health clinic services, $2; 
Substance abuse services, $2; 
Q. 
Hospital inpatient services, $3 per patient day; 
R. 
Federally qualified health center services, $3 per patient day, effective July 1, 
2004; and 
S. 
Rural health center services, $3 per patient day. 
The department may adopt rules to adjust the copayments set forth in this subsection. 
The rules may adjust amounts to ensure that, except as provided in subsection 8, 
copayments are deemed considered 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 
1392(a)(30)(A) or any successor provision of law must be considered in any reduction in 
reimbursement to providers or imposition of copayments. 
Sec. 2. 22 MRSA §3173-C, sub-§8 is enacted to read: 
Page I - 123LR2306(Ol)-1 
8. 
Increased copayments. Notwithstanding any provision of this section to the 
contrary, beginning January 1, 2008, increased copayments per service per day are 
imposed and reimbursements are reduced, or both, as provided in this subsection. 
A. 
The department shall adopt rules to increase the copayments of MaineCare 
members who smoke tobacco products, as defined in section 1580, miss 
appointments with health care practitioners, as defined in section 1711-C, subsection 
1, paragraph F, or misuse prescription drugs, which, for purposes of this paragraph, 
means using prescription drugs in a manner that is not in compliance with the 
instructions of the prescribing health care practitioner after the MaineCare member 
has been instructed in the proper use and warned against misuse on more than one 
occasion. 
B. 
The rules adopted under paragraph A must double the copayment otherwise 
applicable to a MaineCare member described under paragraph A and make payment 
mandatory for the MaineCare member to obtain service under the MaineCare 
program. 
C. 
Rules adopted pursuant to this subsection are routine technical rules as defined 
by Title 5, chapter 375, subchapter 2-A. 
SUMMARY 
This bill requires increased copayments that are mandatory for the MaineCare 
program beginning January 1, 2008 for members who smoke tobacco products, who miss 
appointments with health care practitioners without just cause or who misuse prescription 
drugs. The copayments are double the normal amount and are mandatory for the member 
to obtain MaineCare services. The bill requires the Department of Health and Human 
Services to adopt routine technical rules to impose the new copayments.