An Act To Require Health Insurance Carriers aidthe MaineCare Program To Cover the Cost of Transition Services To Bridge the Gap between High School and Independence
Maine Legislature, Session 126, LD 1367
Committee Amendment CA_A_H717 (House)
Amends: 22 MRSA §3174-X

COMMITTEE AMENDMENT" 11 " to H.P. 975, L.D. 1367, Bill, "An Act To 
Require Health Insurance Carriers aidthe MaineCare Program To Cover the Cost of 
Transition Services To Bridge the Gap between High School and Independence" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Decrease Costs and Disability Due to Mental Illness in Children, 
Adolescents and Young Adults' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA §3174-XX is enacted to read: 
§3174-XX. Mental and behavioral health services for children, adolescents and 
young adults 
The department shall provide reimbursement under the MaineCare program for care 
coordination and assertive community treatment services for eligible persons who are 26 
years of age or under who meet the criteria for a psychiatric diagnosis in the Diagnostic 
and Statistical Manual of Mental Disorders, 5th edition, published by the American 
Psychiatric Association and experience significant impairment in function as determined 
by a licensed mental health provider. 
For the purposes of this section, "assertive 
community treatment services" means self-contained services with a fixed point of 
responsibility 
for 
providing treatment, counseling, 
vocational 
and 
educational 
rehabilitation and support services to eligible persons who are 26 years of age or under 
and their families for whom other community-based treatment approaches have been 
unsuccessful. In accordance with the assertive community treatment scale developed by 
Dartmouth College, assertive community treatment uses principles of care coordination, 
chronic illness management and evidence-based therapies to minimize fragmentation of 
care and maximize care coordination for persons whose symptoms of mental illness result 
in serious functioning difficulties in multiple areas of life, including family relationships, 
social relationships, education, employment, residential independence, medical health, 
substance abuse and psychotropic medication management. 
Assertive community 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT 'A" to H.P. 975, L.D. 1367 
treatment is provided by multidisciplinary teams who are on duty 24 hours per day, 7 
days per week; a team includes a psychiatrist, a registered psychiatric nurse, licensed 
clinical social workers, community support workers and vocational and educational 
specialists and may include a peer recovery specialist or a substance abuse counselor. 
Sec. 2. 24-A MRS A §4320-1 is enacted to read: 
§4320-I. Mental and behavioral health services for children, adolescents and young 
adults 
A carrier shall provide coverage for care coordination and assertive community 
treatment services for eligible persons who are 26 years of age or under who meet the 
criteria for a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental 
Disorders, 5th edition, published by the American Psychiatric Association and experience 
significant impairment in function as determined by a licensed mental health provider. 
For the purposes of this section, "assertive community treatment services" means self-
contained services with a fixed point of responsibility for providing treatment, 
counseling, vocational and educational rehabilitation and support services to eligible 
persons who are 26 years of age or under and their families for whom other community-
based treatment approaches have been unsuccessful. In accordance with the assertive 
community treatment scale developed by Dartmouth College, assertive community 
treatment uses principles of care coordination, chronic illness management and evidence-
based therapies to minimize fragmentation of care and maximize care coordination for 
persons whose symptoms of mental illness result in serious functioning difficulties in 
mUltiple areas of life, including family relationships, social relationships, education, 
employment, residential independence, medical health, substance abuse and psychotropic 
medication 
management. 
Assertive 
community 
treatment 
is 
provided 
by 
multidisciplinary teams who are on duty 24 hours per day, 7 days per week; a team 
includes a psychiatrist, a registered psychiatric nurse, licensed clinical social workers, 
community support workers and vocational and educational specialists and may include a 
peer recovery specialist or a substance abuse counselor. 
Sec. 3. Transition services. The Department of Health and Human Services shall 
require each provider of mental and behavioral health services for children to establish or 
participate in so-called bridge teams for the purpose of ensuring continuity of care for 
students receiving mental and behavioral health services who graduate from high school. 
The bridge teams shall conduct outreach and identify students prior to graduation who are 
likely to be in need of mental and behavioral health services after graduation, develop 
plans to meet those students' needs after graduation, facilitate access to services and 
coordinate the continuance of care for those students after graduation. When developing 
plans for students, the bridge teams shall focus on prevention, continuity of treatment and 
avoidance of hospitalization. 
Sec. 4. Application. That section of this Act that enacts the Maine Revised 
Statutes, Title 24-A, section 4320-1 applies to all policies, contracts and certificates 
executed, delivered, issued for delivery, continued or renewed in this State on or after 
January 1,2015. For the purposes of Title 24-A, section 4320-1, all contracts are deemed 
to be renewed no later than the next yearly anniversary of the contract date.' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'A" to H.P. 975, L.D. 1367 
SUMMARY 
This amendment is the majority report of the committee and replaces the bill and 
changes the title. The amendment requires the MaineCare program and health insurance 
carriers to provide coverage for care coordination and assertive community treatment 
services for eligible persons who are 26 years of age or under who meet the criteria for a 
psychiatric diagnosis and experience significant impairment in function as determined by 
a licensed mental health provider. 
The amendment adds a definition of "assertive 
community treatment services." The requirements imposed on health insurance carriers 
apply to individual, group health and group health maintenance organization insurance 
policies, contracts and certificates issued or renewed on or after January 1, 20 IS. The 
amendment specifies the scope and length of coverage for eligible persons based on age 
rather than referring to persons who have graduated from high school as in the bill. The 
amendment also more specifically describes the types of services required to be covered. 
The amendment also requires the Department of Health and Human Services to 
require providers of mental and behavioral health services for children to establish or 
participate in so-called bridge teams for the purpose of ensuring continuity of care for 
students receiving mental and behavioral health services who graduate from high school 
and are likely to be in need of such services following graduation. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Revised: 03/17114 
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LD 1367 
LR 1550(02) 
An Act To Require Health Insurance Carriers and the MaineCare Program To Cover the Cost of 
Transition Services To Bridge the Gap between High School and Independence 
Fiscal Note for ~ill as Amended by C~mmi~tee Am~ndment JI" (Ii -111 ') 
CommIttee: Insurance and FInancial ServIces 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
Projections Projections FY 
FY 2013-14 
FY 2014-15 
FY 2015-16 
2016-17 
$0 
$0 
$0 
$0 
$0 
$0 
$0 
$0 
$82,300 
$30,780 
$82,300 
$30,780 
$88,884 
$33,24: 
$88,884 
$33,243 
Expanding required coverage for behavioral health services for eligible persons up to age 26 is estimated to have an 
overall cost to the State Employee Health Insurance Program of $210,00 in 2015-16 based on an assumed cost of 
0.1 % of total claims. Of this total, the cost to General Fund programs is estimated to be $82,300 in 2015-16 and 
$88,884 in 2016-l7. The impact on Highway Fund programs is estimated to be $30,780 in 2015-16 and $33,243 in 
2016-17. Because of the effective date for plan years beginning on or after January 1, 2015, it is not assumed to have 
an impact in the current biennium given the State's current July through June plan year. 
The fiscal impact of the amended bill on the Department of Health and Human Services' MaineCare program cannot 
be determined at this time. The department believes the age groups specified in the amendment are already being 
covered f6r these services under existing MaineCare polices. Any potential savings to MaineCare from shifting costs 
to private insurers cannot be determined at this time. 
LR1550(02) - Fiscal Note - Page 1 of 1 
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