An Act To Save Lives by Establishing the Low Barrier Opioid Treatment Response Program
Maine Legislature, Session 129, LD 1662
Committee: Health and Human Services
Sponsors: CLAXTON, O'CONNOR, PERRY
Amends: 22 MRSA §259, 22 MRSA §2354

Legislative Document
No. 1662
S.P. 539
In Senate, April 30, 2019
An Act To Save Lives by Establishing the Low Barrier Opioid 
Treatment Response Program
(EMERGENCY)
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator CLAXTON of Androscoggin.
Cosponsored by Representatives: O'CONNOR of Berwick, PERRY of Calais.
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, opioid use disorder has reached epidemic proportions and threatens the 
lives and well-being of many Maine residents; and
Whereas, existing modalities and strategies for treatment of opioid use disorder are 
insufficient to end the epidemic of this disorder in Maine; and
Whereas, existing services are especially inadequate to address the impact of opioid 
use disorder on those experiencing or having experienced unstable housing, minimal or 
no employment, unreliable transportation, lack of insurance coverage, use of multiple 
substances, frequent hospitalization or prior overdoses; and
Whereas, failure to provide timely treatment to those most at risk of overdose death 
from opioid use leads to unnecessary loss of life and tragic dislocations of family life, 
while imposing substantial additional costs on the State due to related increases in 
incarcerations, hospital admissions and foster care for children affected by parental use of 
opioids; and
Whereas, a low barrier, rapid access treatment system delivered and coordinated by 
Maine's community health centers will provide an essential component of an improved 
array of responses to this epidemic; 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:
Sec. 1.  22 MRSA §259, sub-§1, ¶B, as amended by PL 2015, c. 267, Pt. JJJ, §1, 
is further amended to read:
B.  Six hundred ninety-nine thousand, one hundred fifty dollars in fiscal year 2001-02 
to federally qualified health centers to support the infrastructure of these programs in 
providing primary care services to underserved populations.  Forty-four thousand, 
two hundred fifty dollars must be provided to each federally qualified health center 
with an additional $8,850 for the 2nd and each additional site operated by a federally 
qualified health center.  For the purposes of this paragraph, "site" means a site or sites 
operated by the federally qualified health center within its scope of service that meet 
all health center requirements, including providing primary care services, regardless 
of patients' ability to pay, 5 days a week with extended hours.  If there is not 
sufficient funding to meet the formula in this paragraph, the $699,150 must be 
allocated in proportion to the formula outlined in this paragraph; and
Sec. 2.  22 MRSA §259, sub-§1, ¶C, as enacted by PL 2015, c. 267, Pt. JJJ, §1, is 
amended to read:
C.  Five hundred thousand dollars, beginning with fiscal year 2015-16 and continuing 
each fiscal year thereafter, to support access to primary medical, behavioral health 
and dental services to residents of the State in rural and underserved communities and 
to assist with provider recruitment and retention.  Twenty-five thousand dollars must 
be provided to each federally qualified health center.; and
Sec. 3.  22 MRSA §259, sub-§1, ¶D is enacted to read:
D.  Four hundred thousand dollars, beginning with fiscal year 2019-20 and 
continuing each fiscal year thereafter, to support pilot implementation and operation 
of the Low Barrier Opioid Treatment Response Program established in section 2354, 
to be allocated by the department to those federally qualified health centers approved 
to participate in the pilot and subsequent implementation.  The funds provided 
pursuant to this paragraph are in addition to and do not alter or amend the purposes or 
the allocation of the funds provided pursuant to paragraph C.
Sec. 4.  22 MRSA §2354 is enacted to read:
§2354.  Low Barrier Opioid Treatment Response Program
1.  Program establishment.  The Low Barrier Opioid Treatment Response Program, 
referred to in this section as "the program," is established in the department to provide 
resources for federally qualified health centers, referred to in this section as "community 
health centers," to develop and deploy low barrier, rapid access treatment models to treat 
opioid use disorder.  The program must provide low barrier, rapid access to treatment for 
those persons typically unable to obtain timely treatment and at greatest risk of opioid 
overdose, including but not limited to persons affected by unstable housing, minimal or 
no employment, unreliable transportation, use of multiple substances associated with 
addiction or chronic overuse, frequent hospitalization, prior overdoses or a lack of health 
insurance coverage for substance use treatment services.
2.  Program components.  The program must include:
A.  Support for clinic infrastructure to reduce barriers to access to treatment, 
including incentives for community health centers to support additional qualified 
providers in obtaining waivers to provide medication-assisted therapy services and 
support for each community health center to identify and compensate an individual 
within that community health center to help implement the program;
B.  Support for community health centers to incentivize providers to accept increased 
call responsibilities and to see greater numbers of patients with opioid use disorders;
C.  A statewide program of anti-stigma training that includes providers, staff and 
community health center patient-led boards;
D.  Support for the development and implementation of a standardized induction 
practice across all participating community health centers;
E.  Increasing the availability of naloxone hydrochloride to community health centers 
and training community health center personnel on the emergency administration of 
naloxone hydrochloride; and
F.  Strategies to increase the number of providers willing to issue prescriptions for 
medication-assisted therapy services in a manner that facilitates rapid access to 
treatment.
3.  Implementation; pilot.  The department shall initially implement the program as 
a pilot project and shall subsequently expand the program to all community health centers 
in accordance with this subsection.
A.  The pilot project must be operated by at least 3 community health centers selected 
on the basis of applications demonstrating interest in implementing the program and 
capacity to implement the program.  The department shall strive to approve 
applications of community health centers of varying sizes and as geographically 
diverse as practicable given the pool of applicants.  The department may phase in 
selected elements of the program over the course of the pilot project.  Community 
health centers participating in the pilot project shall collect information on and report 
to the department the number of patients served in the program and, for each patient 
served:
(1)  Emergency department utilization and hospital admissions;
(2)  Time elapsed between first patient encounter and delivery of services in the 
program; and
(3)  Any other outcome and quality indicators that the department may specify 
after consultation with participating health centers, without duplicating other 
existing reporting requirements.
B.  After review of the data reported during the pilot project, the department shall 
expand the program to include all community health centers, on a schedule and with 
such financial support as the department determines to be appropriate and sufficient 
to address the statewide need for the program.
4.  Reimbursement.  The department shall modify and supplement the 
reimbursement of community health centers provided under section 3174-V to the extent 
necessary to implement this section.
5.  Rules.  The department shall adopt routine technical rules pursuant to Title 5, 
chapter 375, subchapter 2-A to implement the provisions of this section.
Sec. 5.  Review of barriers.  In conjunction with review of the reports provided 
pursuant to the Maine Revised Statutes, Title 22, section 2354, subsection 3, paragraph A, 
the Department of Health and Human Services and representatives of federally qualified 
health centers shall examine the extent to which existing structures for reimbursement 
and delivery of services by federally qualified health centers and other providers may 
hamper or facilitate access to opioid use disorder treatment and develop proposed 
changes to address identified barriers, reduce unnecessary costs and enhance coordination 
between other providers and federally qualified health centers in serving persons at risk 
of opioid overdose.  The department, with input from providers, shall present a report 
with the findings under this section to the Joint Standing Committee on Health and 
Human Services no later than January 15, 2020.  The report must address the 
effectiveness of the implementation of the pilot project established pursuant to Title 22, 
section 2354, subsection 3, the schedule for full implementation and the extent of any 
additional funding needed to accomplish full implementation.
Sec. 6.  Appropriations and allocations.  The following appropriations and 
allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Community Health Center Investment Fund
Initiative:  Provides funds to establish and implement a pilot project for a low barrier, 
rapid access treatment program for opiate use disorder and other substance use disorders 
to be delivered by Maine's federally qualified health centers under the department's 
direction and in collaboration with other health care providers, with funds in addition to 
Medicaid reimbursement distributed to health centers pursuant to the Maine Revised 
Statutes, Title 22, section 259.
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved.
SUMMARY
This bill requires the Department of Health and Human Services to establish the Low 
Barrier Opioid Treatment Response Program in Maine's federally qualified health centers 
to improve the availability of medication-assisted treatment and enhance the effectiveness 
and sustainability of acute care responses to persons in urgent need of treatment for 
substance use disorders, including opioid use disorder.  The department is required to 
implement the program on a pilot basis initially and expand the program statewide after 
reviewing initial outcomes of the pilot.
It also directs the department and representatives of federally qualified health centers 
to examine the extent to which existing structures for reimbursement and delivery of 
services by federally qualified health centers and other providers may hamper or facilitate 
access to opioid use disorder treatment and develop proposed changes to address 
identified barriers, reduce unnecessary costs and enhance coordination between federally 
qualified health centers and other providers serving persons at risk of opioid overdose.  
The department is required to report findings on these subjects and on initial pilot 
implementation of the Low Barrier Opioid Treatment Response Program to the Joint 
Standing Committee on Health and Human Services no later than January 15, 2020.
GENERAL FUND
2019-20
2020-21
All Other
$400,000
$400,000
GENERAL FUND TOTAL
$400,000
$400,000