An Act To Repeal the 2-year Limit on Methadone and Suboxone Treatments under MaineCare
Maine Legislature, Session 126, LD 0951
Committee Amendment CA_A_H559 (House)
Amends: 22 MRSA §3174-S, 22 MRSA §3174-V

);'IRST REGULAR SESSION 
COMMITTEE AMENDMENT "A" to H.P. 664, L.D. 951, Bill, "An Act To 
Repeal the 2-year Limit on Methadone and Suboxone Treatments under MaineCare" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Amend the Pri'[lr Authorization Process for Methadone and Suboxone 
Treatments under MaineC are' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the f,)llowing: 
'Sec. 1. 22 MRSA §3174-SS, sub-§l, as enacted by PL 2011, c. 477, Pt. I, § 1, is 
repealed and the following enacted in its place: 
1. Twenty-four month. limit. Beginning January 1, 2013, reimbursement under the 
MaineCare program for buprenomhine and naloxone combination drugs for the treatment 
of addiction to opioids is limited to a total of 24 months except that coverage must be 
provided beyond 24 months if one or more of the following apply: 
A. The individual is pregnant, has a serious and persistent mental illness or resides 
with a child under 3 years of age for whom the individual is primarily responsible; 
B. The individual is taking a daily maintenance amount of 4 milligrams or less; or 
C. The department gives prior authorization for coverage. 
The 24-month limit inc1udt:s months prior to January 1, 2013 for which the individual 
received coverage. 
The department shall adopt rules to implement this subsection. Rules adopted pursuant to 
this subsection are routine 1echnical rules as defined by Title 5, chapter 375, subchapter 
2-A. 
Sec. 2. 22 MRSA §3174-VV, as reallocated by RR 2011, c. 2, §27, is repealed 
and the following enacted in its place: 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT'A" to H.P. 664, L.D. 951 
§3174-VV. Methadone reimbursement limitations 
1. Twenty-four month limit. Effective January 1, 2013, reimbursement under the 
MaineCare program for methadone for the treatment of addiction to opioids is limited to a 
lifetime maximum of 24 months, except that coverage must be provided beyond 24 
months if one of the following apply: 
A. The individual is pregnant, has a serious and persistent mental illness or resides 
with a child under 3 years of age for whom the individual is primarily responsible; 
B. The individual is taking an adequate daily amount that is considered to be a 
maintenance amount; or 
C. The department gives prior authorization for coverage. 
2. Rulemaking. The department shall adopt rules to implement this section. Rules 
adopted pursuant to this subsection are routine technical rules as defined by Title 5, 
chapter 375, subchapter 2-A. The rules must include a determination of an amount 
considered a maintenance amount pursuant to subsection 1, paragraph B. 
Sec. 3. 
Department of Health and Human Services to increase 
MaineCare reimbursement rates. The Department of Health and Human Services 
shall amend its MaineCare rules regarding reimbursement rates paid to methadone clinics 
to increase the rate from $60 a week to $70 a week beginning October 1, 2013. 
Sec. 4. Appropriations and allocations. 
The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY BDS) 
Mental Health Services - Community Medicaid 0732 
Initiative: Provides funds to allow MaineCare reimbursement for methadone for the 
treatment of addiction to opioids under certain conditions. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2013-14 
$0 
$0 
2014-15 
$208,848 
$208,848 
Office of Substance Abuse - Medicaid Seed 0844 
Initiative: Provides funds to allow MaineCare reimbursement for methadone for the 
treatment of addiction to opioids under certain conditions. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
$60,237 
$60,237 
v..O~S 
COMMITTEE AMENDMENT i~\ "to H.P. 664, L.D. 951 
HEAL TH AND HUMAl\ SERVICES, 
DEPARTMENT OF (FORMERLY BDS) 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL - ALL FUNDS 
2013-14 
2014-15 
$0 
$269,085 
$0 
$269,085 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
Initiative: Provides funds to allow MaineCare reimbursement for buprenorphine and 
naloxone combination drugs for the treatment of addiction to opioids under certain 
conditions. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Medical Care - Payments to Providers 0147 
2013-14 
$207,956 
$207,956 
2013-14 
$336,503 
$336,503 
2014-15 
$209,345 
$209,345 
2014-15 
$335,115 
$335,115 
Initiative: Provides funds to allow MaineCare reimbursement for methadone for the 
treatment of addiction to opioids under certain conditions. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITlURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
$329,342 
$329,342 
2014-15 
$957,949 
$957,949 
\tO~S 
COMMITTEE AMENDMENT 'A "to H.P. 664, L.D. 951 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
DEPARTMENT TOTAL-ALL FUNDS 
SECTION TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
SECTION TOTAL - ALL FUNDS 
2013-14 
$207,956 
$336,503 
$544,459 
2013-14 
$207,956 
$336,503 
$544,459 
2014-15 
$538,687 
$1,293,064 
$1,831,751 
2014-15 
$807,772 
$1,293,064 
$2,100,836 
Sec. 5. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
Initiative: Provides funds to increase reimbursement rates paid to methadone clinics from 
$60 a week to $70 a week beginning October 1,2013. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
SUMMARY 
2013-14 
$370,383 
$370,383 
2013-14 
$599,333 
$599,333 
2014-15 
$497,141 
$497,141 
2014-15 
$795,813 
$795,813 
This amendment replaces the bill and is the majority report of the committee. The 
amendment amends the prior authorization process for methadone and so-called 
Suboxone treatments under MaineCare. 
It allows for the continuation of coverage, 
without prior authorization, if the individual receiving the treatment is pregnant, has 
serious and persistent mental illness or resides with a child under 3 years of age for whom 
the individual is primarily responsible. It also allows an individual who is on a low daily 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT 'fA" to H.P. 664, L.D. 951 
dose that is considered a maintenance dose to continue coverage without prior 
authorization. For Suboxone, this amount is 4 milligrams. The maintenance dose for 
methadone will be determined in the Department of Health and Human Services rules. 
The amendment also directs the department to increase the reimbursement rates paid to 
methadone clinics from $60 a week to $70 a week. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Revised: 06/18/13 Mac.. 
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LD951 
LR 1577(02) 
An Act To Repeal the 2-year Limit on Methadone and Suboxone Treatments under MaineCare 
Fiscal Note for Bill as Amended by Committee Amendment ~ 
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Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2013-14 
$578,339 
$578,339 
$935,836 
FY 2014-15 
$1,304,913 
$1,304,913 
$2,088,877 
Projections 
FY2015-16 
$1,903,338 
$1,903,338 
$3,046,825 
Projections 
FY 2016-17 
$1,903,338 
$1,903,338 
$3,046,825 
This bill includes General Fund appropriations totalling $578,339 in fiscal year 2013-14 and $1,304,913 in fiscal year 
2014-15 for the Department of Health and Human Services. It includes a General Fund appropriation of $207,956 in 
fiscal year 2013-14 and $807,772 in fiscal year 2014-15 to allow MaineCare reimbursement for buprenorphine and 
naloxone combination drugs and methadone for the treatment of addiction to opioids under certain conditions. The 
General Fund cost to increase the MaineCare rate paid to methadone clinics is $370,383 in fiscal year 2013-14 and 
$497,141 in fiscal year 2014-15. 
LRI577(02) - Fiscal Note - Page 1 of 1