An Act To Support the Fidelity and Sustainability of Assertive Community Treatment
Maine Legislature, Session 130, LD 0582
Committee: Health and Human Services
Sponsors: MADIGAN
Amends: 34-B MRSA §3801

Legislative Document
No. 582
H.P. 425
House of Representatives, February 24, 2021
An Act To Support the Fidelity and Sustainability of Assertive 
Community Treatment
(EMERGENCY)
Received by the Clerk of the House on February 22, 2021.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative MADIGAN of Waterville.
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, this legislation needs to take effect before the expiration of the 90-day 
period because MaineCare reimbursement rates for providing individualized intensive 
integrated mental health services, known as "assertive community treatment," have not 
been adjusted in many years and are insufficient to enable some providers to continue to 
provide services; and
Whereas, the parameters and requirements for individualized intensive integrated 
mental health services must be reformed immediately in order to sustain the availability 
and effectiveness of these services by providing resources and criteria that support the 
fidelity of the assertive community treatment model; 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.  34-B MRSA §3801, sub-§4-C is enacted to read:
4-C.  Medical assistant.  "Medical assistant" means a person to whom certain activities 
relating to medical care and treatment have been delegated by a licensed physician or 
surgeon in compliance with Title 32, section 2594-A or 3270-A.
Sec. 2.  34-B MRSA §3801, sub-§7-C is enacted to read:
7-C.  Psychiatric provider.  "Psychiatric provider" means a licensed health care 
provider with psychiatric training or experience, including without limitation a psychiatrist, 
psychiatric nurse practitioner or physician assistant.
Sec. 3.  34-B MRSA §3801, sub-§11, as amended by PL 2017, c. 407, Pt. A, §159, 
is further amended to read:
11.  Assertive community treatment.  "Assertive community treatment" or "ACT" 
means a self-contained, evidence-based service with a fixed point of responsibility for 
providing treatment, rehabilitation and support services to persons with mental illness for 
whom other community-based treatment approaches have been unsuccessful.  Assertive 
community treatment uses clinical and rehabilitative staff to address symptom stability; 
relapse prevention; maintenance of safe, affordable housing in normative settings that 
promote well-being; establishment of natural support networks to combat isolation and 
withdrawal; the minimizing of involvement with the criminal justice system; individual 
recovery education; and services to enable the person to function at a work site. Assertive 
community treatment is provided by multidisciplinary teams who are on duty 24 hours per 
day, 7 days per week; teams must include a psychiatrist psychiatric provider, registered 
nurse, certified rehabilitation counselor or certified employment specialist, a peer recovery 
specialist and a substance use disorder counselor and may include an occupational 
therapist, community-based mental health rehabilitation technician, psychologist, licensed 
clinical social worker or, licensed clinical professional counselor, medical assistant or 
person with training demonstrated by a 4-year postsecondary or graduate degree in a mental 
health related field.  An ACT team member who is a state employee is, while in good faith 
performing a function as a member of an ACT team, performing a discretionary function 
within the meaning of Title 14, section 8104‑B, subsection 3.
Sec. 4.  Reimbursement rate increase.  The Department of Health and Human 
Services shall increase reimbursement rates under rule Chapter 101: MaineCare Benefits 
Manual, Chapters II and III, Section 17 for assertive community treatment by 25% 
beginning on the effective date of this Act.
Sec. 5.  Rulemaking.  The Department of Health and Human Services shall amend 
its rules governing the assertive community treatment, or ACT, program within 6 months 
after the effective date of this Act, with appropriate stakeholder involvement, to make the 
following changes to the program:
1.  Provide for a per member, per month reimbursement model that ensures adequate 
resources to provide services achieving fidelity to the evidence-based model for ACT 
services, using a per member, per month payment model;
2.  Ensure that limits are not placed on the duration of ACT services to any recipient 
and that ACT services remain the point of contact for all clients meeting the eligibility 
requirements for ACT for as long as necessary;
3.  Provide an initial authorization period of one year for clients meeting eligibility 
requirements for ACT and require reauthorization no more often than annually thereafter;
4.  Allow billing for services under the program for coordination of care during an 
initial engagement period of 90 days, when the recipient of those services is temporarily 
admitted to a hospital or resident in a jail or prison in this State and when the recipient is 
making a transition to a lower level of care, recognizing that the fidelity of the program to 
the ACT model requires continuity of treatment;
5.  Clarify that the minimum contact requirement is 3 contacts weekly on average over 
each year of authorized service and that a contact may be face to face, through a closed 
door or an outreach attempt at the home or in the community, including without limitation 
street outreach; and
6.  Ensure that medical eligibility to receive services under the program reflects an 
evidence-based understanding of the diagnoses and circumstances in which ACT is 
effective.
Rules adopted pursuant to this section are routine technical rules as defined in the 
Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
SUMMARY
This bill modifies the definition of "assertive community treatment" to better align the 
definition with an evidence-based treatment model.  The bill adds definitions of 
"psychiatric provider" and "medical assistant" and changes the description of the 
composition of the multidisciplinary teams that provide assertive community treatment.  
The bill also requires the Department of Health and Human Services to increase the 
MaineCare reimbursement rates for assertive community treatment by 25% immediately to 
allow providers to continue to offer the service.  The bill also requires the department to 
adopt rules to transition to a per member, per month payment model and to reform the 
criteria and operation of the program to ensure its fidelity to the evidence-based model for 
assertive community treatment services.