An Act To Develop a Statewide Resource and Referral Center and Develop Hub-and-spoke Models To Improve Access, Treatment and Recovery for Those with Substance Use Disorder
Maine Legislature, Session 128, LD 1430
Committee Amendment CA_A_H715 (House)
Amends: 5 MRSA §20003, 5 MRSA §20054

COMMITTEE AMENDMENT "ft,, to H.P. 984, L.D. 1430, Bill, "An Act To 
Develop a Statewide Resource and Referral Center and Develop Hub-and-spoke Models 
To Improve Access, Treatment and Recovery for Those with Substance Use Disorder" 
Amend the bill by striking out everything after the title and before the summary and 
inserting the following: 
'Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, Maine is in the midst of an epidemic of opioid use disorder in which over 
2, 100 Maine individuals have died as a result of opioid overdoses since 2009; and 
Whereas, individuals in Maine suffering from opioid and other substance use 
disorder lack access to treatment and support; and 
Whereas, individuals can successfully recover from opioid and other substance use 
disorder with appropriate treatment and support; and 
Whereas, this legislation seeks to address this urgent issue by requiring the 
Department of Health and Human Services to oversee and provide funding to support a 
statewide comprehensive system of services that provides access to integrated 
medicationwassisted treatment; and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore, 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-1. 5 MRSA §20003, sub-§13-A is enacted to read: 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT .. 4, to H.P. 984, L.D. 1430 
13-A. Hub. "Hub" means an organization licensed by the de12artment that provides 
timely access to com12rehensive, integrated assessment, treatment and recovery support 
for individuals with substance use disorder, including but not limited to 012ioid use 
disorders. Hyb services may ge provided )?y licensed behavioral health organizations, 
comm~ity mental health centers, m~thadone clinics, hospitals and federally qualified 
health centers. 
Sec. A-2. 5 MRSA §20003, sub-§15-A is enacted to read: 
15-A. Integrated medication-assisted treatment. "Integrated medication-assisted 
treatment" means a treatment method that combines medication approved by the federal 
Food and Drug Administration for the treatment of substance use disorder with 
counseling, urine drug screening and behavioral therapy that has proven effective in 
treating substance use disorder. 
Sec. A-3. 5 MRSA §20003, sub-§16-A is enacted to read: 
16-A. Levels of care. "Levels of care" means the continuum of recovery-oriented 
services that reflect an individual1s risks, needs, strengths, resources and skills as 
determined by an assessment with standardized placement criteria conducted by a 
qualified clinician. 
Sec. A-4. 5 MRSA §20003, sub-§19-A is enacted to read: 
19-A. Recovery support services. ''Recovery support services" means services that 
1·ecognize recovery is a process of change through which individuals improve their health 
and wellness, live self-directed lives and strive to reach their full potential, including, but 
not limited to, safe housing, transportation, peer mentoring and coaching and assistance 
with and access to em12loyment services. 
"Recovery sup12ort services" may include 
services 12rovided in an integrated medication-assisted treatment setting or in a separate 
facility that is staffed by individuals in recovery and that provides services such as 
mentoring, education and resource provision. 
Sec. A-5. 5 MRSA §20003, sub-§19-B is enacted to read: 
19-B. 
Spoke. 
11Spoke
means a community-based provider, including, but not 
limited to, a primary care provider, that provides integrated medication-assisted treatment 
and behavioral health treatment and recovery support services to patients with substance 
use disorder, including, but not limited to, 012ioid use disorder, or refers those patients to 
such treatments or services. 
Sec. A-6. 5 MRSA §20054 is enacted to read: 
§20054. Hub-and-spoke model 
No later than October 1, 2018, the department shall ensure that a continuum of 
evidence-based treatment and recovery su12port services for opioid use disorder is 
accessible to all people in this State through contracts with hubs and spokes. 
Hub 
providers may refer patients to spokes when clinically appropriate, and spokes may refer 
patients to hubs when clinically appropriate. The department shall provide funds to hubs 
and spokes to support the development of treatment capacity. The department shall also 
provide funds to hubs and spokes for treatment, including medication, for individuals 
who lack insurance or the ability to pay for treatment. The department shall provide 
COMMITTEE AMENDMENT 
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7. 
COMMITTEE AMENDMENT"~ to H.P. 984, L.D. 1430 
funds to support recovery support services for individuals receiving treatment from hubs 
and spokes. The department shall ensure that individuals have access to the appropriate 
levels of care that meet the individuals' need, as determined by an assessment by a 
treating clinician. A hub is eligible to receive funding under this section only if the hub 
has the capacity to assess and treat or refer patients with multiple behavioral health 
diagnoses. 
A hub shall provide or contract for comprehensive services including 
intensive outpatient programs and integrated medication assisted treatment for individuals 
with acute needs. A hub shall provide or coordinate with recovery support services. 
PARTB 
Sec. B-1. Department of Health and Human Services to seek federal 
funding. The Department of Health and Human Services, referred to in this Part as "the 
department," shall assess federal funding opportunities to support integrated medication-
assisted treatment and a hub-and-spoke model of delivery of services for opioid and 
substance use disorder as described in the Maine Revised Statutes, Title 5, section 20054 
and distribute resources to hubs and spokes based on identified needs. 
Sec. B-2. Development of grant funding for education. The department shall 
provide grant funding, when available, to hubs or other qualified entities to provide 
assistance with the development of hub-and-spoke infrastructure, as well as initial 
training and ongoing education to hub-and-spoke providers across the State. Qualified 
entities may include providers that deliver health care services to meet the health needs of 
target populations. 
Sec. B-3. Provide treatment to uninsured individuals seeking treatment. 
The department shall provide funds to support treatment for uninsured individuals 
seeking integrated medication-assisted treatment. 
Sec. B-4. 
Evaluation and assessment. 
The department shall develop 
assessment measures for performance evaluation of the hub-and-spoke model. 
Assessment measures must include statistics regarding referrals of individuals seeking 
substance use disorder treatment; treatment for substance use disorder; success rates, 
including recovery engagement, adherence to medication-assisted treatment protocols, 
stability and workplace participation; wait time for services; and any other relevant 
measures. 
Sec. B-5. 
Maine information. 
The department shall support the 
development of a plan to create a statewide resource and referral center for substance use 
disorder treatment and recovery resources that uses the existing 211 Maine service and 
links it with comprehensive, statewide information on available treatment and recovery 
resources. The department shall work collaboratively with the United Ways of Maine 
and 211 Maine to develop this plan, as well as with substance use disorder treatment 
providers and individuals from the substance use disorder recovery community. 
Sec. B-6. Report. No later than February 1, 2019, the department shall report to 
the joint standing committee of the Legislature having jurisdiction over health and human 
services matters on the progress and implementation of the hub-and-spoke model, federal 
funding, grants dispersed, evaluation and assessment measures and improvement of the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "H" to H.P. 984, L.D. 1430 
Maine service. The joint standing committee of the Legislature having jurisdiction 
over health and human services matters is authorized to report out legislation to the First 
Regular Session of the 129th Legislature related to the report. 
PARTC 
Sec. C-1. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Office of Substance Abuse and Mental Health Services Z199 
Initiative: Provides funding beginning in fiscal year 2018-19 to hubs and spokes to cover 
costs of intensive, intermediate and long-term treatment, including, but not limited to, the 
cost of medication, screening, behavioral health treatment, urine drug screens, office 
visits and recovery support services for individuals with opioid use disorder, including 
those who are uninsured. The department may use a portion of the funds to support 
training and education of hubs and spokes. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2017-18 
$0 
$0 
2018-19 
$6,663,000 
$6,663,000 
Emergency clause. 
In view of the emergency cited in the preamble, this 
legislation takes effect when approved.' 
SUMMARY 
This amendment, which is the majority report of the committee, replaces the bill. It 
establishes the hub-and-spoke system in statute. It establishes definitions for "hub," 
"spoke," "levels of care," "integrated medication-assisted treatment" and "recovery 
support services." It requires the Department of Health and Human Services to support a 
hub-and-spoke system. It clarifies that the department must assess opportunities for 
federal funding and provide grants for training when funding is available. It requires the 
department to support the development of a plan to create a statewide resource and 
referral center for substance use disorder treatment that uses 211 Maine and links it with 
comprehensive statewide information on available treatment and recovery resources. It 
requires a report from the department to the joint standing committee of the Legislature 
having jurisdiction over health and human services matters by February 1, 2019. It 
includes an appropriations and allocations section. It also adds an emergency preamble 
and emergency clause. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/19/18 feac.. 
·· 12Sth MAINE .. LEGISLATURE 
.,. 
LD 1430 
LR 1701(02) 
An Act To Develop a Statewide Resource and Referral Center and Develop Hub-and-spoke Models To 
Improve Access, Treatment and Recovery for Those with Substance Use Disorder 
':" \ 
Fiscal Note for Bill as Amended by Committee Amendment A' ( H 
~ 715_) 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2017-18 
FY 2018-19 
$0 
$6,663,000 
$0 
$6,663,000 
Projections 
FY 2019-20 
$6,663,000 
$6,663,000 
Projections 
FY2020-21 
$6,663,000 
$6,663,000 
The bill includes an ongoing General Fund appropriation to the Department of Health and Human Services of 
$6,663,000 beginning in fiscal year 2018-19 to hubs and spokes to cover costs of intensive, intermediate and long-
term treatment, including, but not limited to, the cost of medication, screening, behavioral health treatment, urine drug 
screens, office visits and recovery support services for individuals with opioid use disorder, including those who are 
uninsured. The department may use a portion of these funds to support training and education of hubs and spokes. 
LR1701(02) - Fiscal Note - Page 1 of 1