An Act To Prohibit Prior Authorization Requirements and Step Therapy Protocols for Medications Addressing Serious Mental Illness for MaineCare Recipients
Maine Legislature, Session 130, LD 1877
Committee Amendment CA_A_H848 (House)
Amends: 22 MRSA §3174-I

COMMITTEE AMENDMENT",,, to H.P. 1387, L.D. 1877, "An Act To Prohibit 
Prior Authorization Requirements and Step Therapy Protocols for Medications Addressing 
Serious Mental Illness for MaineCare Recipients" 
Amend the bill by striking out everything after the enacting clause and before the 
emergency clause and inserting the following: 
'Sec. 1. 22 MRSA §3174-III is enacted to read: 
§3174-ID. Treatment of serious mental illness 
1. Definitions. For purposes of this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Serious mental illness" means a mental disorder listed in the edition of the 
Diagnostic and Statistical Manual of Mental Disorders published by the American 
Psychiatric Association that took effect October 1, 2021 that results in serious 
functional impairment that substantially interferes with or limits one or more major life 
activities. "Serious mental illness" does not include opioid use disorder, tobacco use 
disorder or any other substance use disorder. 
B. "Step therapy" means a protocol or tiering system that establishes a specific 
sequence in which prescription drugs for a specified medical condition are determined 
to be medically necessary for a particular enrollee and are covered under a pharmacy 
or medical benefit by a carrier, including self-administered and physician-administered 
drugs. 
2. Prior authorization or step therapy. The department may not require under the 
MaineCare program prior authorization or step therapy for prescription drugs used for the 
assessment or treatment of serious mental illness in adults. 
3. Drug rebate program. The implementation of this section and any rules adopted 
pursuant to subsection 4 must be consistent with the requirements of the Medicaid drug 
rebate program established in 42 United States Code, Section 1396r-8. The department 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDJVIBNT "A" to H.P. 1387, L.D. 1877 
shall monitor the fiscal impact of implementing this section, including costs to Medicaid 
that are both incurred and avoided. 
4. Rules. The department may adopt rules to implement this section. Rules adopted 
pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375. 
subchapter 2-A. 
Sec. 2. State plan amendment. No later than January 1, 2023, the Department of 
Health and Human Services shall apply to the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services for a state plan amendment 
to eliminate the requirement for prior authorization or a step therapy protocol for 
prescription drugs used for the assessment or treatment of serious mental illness in adults. 
Sec. 3. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care - Payments to Providers 0147 
Initiative: Provides funding associated with changes to the prior authorization requirements 
and step therapy protocols under the MaineCare program for prescription drugs used to 
assess or treat serious mental illness. 
GENERAL FUND 
2021-22 
2022-23 
All Other 
$0 
$721,702 
GENERAL FUND TOTAL 
$0 
$721,702 
FEDERAL EXPENDITURES FUND 
2021-22 
2022-23 
All Other 
$0 
$1,690,973 
FEDERAL EXPENDITURES FUND TOTAL 
$0 
$1,690,973 
FEDERAL BLOCK GRANT FUND 
2021-22 
2022-23 
All Other 
$0 
$36,718 
FEDERAL BLOCK GRANT FUND TOTAL 
$0 
$36,718 
PNMI Room and Board Z009 
Initiative: Provides funding associated with changes to the prior authorization requirements 
and step therapy protocols under the MaineCare program for prescription drugs used to 
assess or treat serious mental illness. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
State-funded Foster Care/Adoption Assistance 0139 
2021-22 
$0 
$0 
COMMITTEE AMENDMENT 
2022-23 
$1,159 
$1,159 
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COMMITTEE AMENDMENT "A" to H.P. 13~7, L.D. 1877 
Initiative: Provides funding associated with changes to the prior authorization requirements 
and step therapy protocols under the MaineCare program for prescription drugs used to 
assess or treat serious mental illness. 
GENERAL FUND 
All Other 
GENERAL FUND TOT AL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
FEDERAL BLOCK GRANT FUND 
DEPARTMENT TOTAL-ALL FUNDS 
2021-22 
$0 
$0 
2021-22 
$0 
$0 
$0 
$0 
2022-23 
$14,609 
$14,609 
2022-23 
$737,470 
$1,690,973 
$36,718 
$2,465,161 
Sec, 4. Contingent effective date. That section of this Act that enacts the Maine 
Revised Statutes, Title 22, section 3174-III takes effect only if: 
1. The United States Department of Health and Human Services, Centers for Medicare 
and Medicaid Services approves a state plan amendment to eliminate the requirement for 
prior authorization or a step therapy protocol for prescription drugs used for assessment or 
treatment of serious mental illness in adults; and 
2. The Commissioner of Health and Human Services notifies the Secretary of State, 
the Secretary of the Senate, the Clerk of the House of Representatives and the Revisor of 
Statutes that written approval for the state plan amendment has been received.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment is the majority report of the committee. It clarifies that "serious 
mental illness" does not include opioid disorder, tobacco use disorder or any other 
substance use disorder for the purposes of this legislation. It clarifies that step therapy 
includes a protocol or tiering system. It specifies that the prohibition on required prior 
authorization or step therapy for serious mental illness applies only to assessment or 
treatment of mental illness in adults. The amendment includes a requirement that the 
implementation must be consistent with the requirements of the Medicaid drug rebate 
program and that implementation requires approval by the federal Department of Health 
and Human Services, Centers for Medicare and Medicaid Services before taking effect. 
The amendment also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 03/22/22 ;:k:TaC'!-
LD 1877 
LR 2383(02) 
An Act To Prohibit Prior Authorization Requirements and Step Therapy Protocols for Medications 
Addressing Serious Mental Illness for MaineCare Recipients 
Fiscal Note for Bill as Amended by Committee Amendment 'A' (H~?1{3) 
Committee: Health and Human Services 
/ 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Federal Block Grant Fund 
Revenue 
Federal Expenditures Fund 
Federal Block Grant Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2021-22 
$0 
$0 
$0 
$0 
$0 
$0 
FY2022-23 
$737,470 
$737,470 
$1,690,973 
$36,718 
$1,690,973 
$36,718 
Projections 
FY 2023-24 
$2,949,881 
$2,949,881 
$6,763,892 
$146,872 
$6,763,892 
$146,872 
Projections 
FY 2024-25 
$2,949,881 
$2,949,881 
$6,763,892 
$146,872 
$6,763,892 
$146,872 
This bill includes General Fund appropriations to the Department of Health and Human Services of $737,470 in fiscal 
year 2022-23 associated with changes to the prior authorization requirements and step therapy protocols under the 
MaineCare program for prescription drugs used to assess or treat serious mental illness in adults. Federal Expenditures 
Fund and Federal Block Grant Fund allocations are also included for the FMAP match. 
LR2383(02) - Fiscal Note - Page 1 of 1