Resolve, Directing the Department of Health and Human Services to Amend MaineCare Rules Governing Certain Types of Behavioral and Mental Health Services and to Form a Stakeholder Group to Study Methods for Improving Those Services (AFTER DEADLINE)
Maine Legislature, Session 131, LD 2243
Committee: Health and Human Services
Sponsors: STEWART, MOORE

Legislative Document
No. 2243
S.P. 965
In Senate, March 5, 2024
Resolve, Directing the Department of Health and Human Services to 
Amend MaineCare Rules Governing Certain Types of Behavioral 
and Mental Health Services and to Form a Stakeholder Group to 
Study Methods for Improving Those Services
(AFTER DEADLINE)
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
205.
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator STEWART of Aroostook.
Cosponsored by Senator: MOORE of Washington.
Sec. 1. Department to amend rules concerning MaineCare reimbursements 
for certain private nonmedical institutions; method of final settlement. 
Resolved: That the Department of Health and Human Services, referred to in this resolve 
as "the department," shall amend its rules in Chapter 101: MaineCare Benefits Manual 
affecting reimbursement for residential services covered in Chapter III, Section 97, 
Appendices E and F and amend, as necessary, any language within Chapter II, Section 97 
and Chapter III, Section 97 that applies to those appendices. The rules must be amended to 
require the department's division of audit to divide its final settlement of a provider's cost 
report into 2 separate calculations as follows:
1. Personnel costs expended by the provider, paid in full to the provider but not to 
exceed what is in the cost report projection; and
2. Operational costs expended by the provider, paid in full to the provider but not to 
exceed what is in the cost report projection.
Sec. 2. Department to amend rules concerning MaineCare reimbursement 
for certain private nonmedical institutions; timing. Resolved: That the 
department shall amend its rules in Chapter 101: MaineCare Benefits Manual, Chapter III, 
Section 97, Appendices E and F and amend, as necessary, any language within Chapter II, 
Section 97 and Chapter III, Section 97 that applies to those appendices to require the 
department to reimburse at least 75% of a private nonmedical institution's as-filed 
settlement pursuant to the facility's cost reports within 90 days of receipt of the cost reports.
Sec. 3. Department to amend rules concerning MaineCare reimbursement 
for outpatient behavioral health services offered in public school setting. 
Resolved: That the department shall amend its rules in Chapter 101: MaineCare Benefits 
Manual, Chapters II and III, Section 65 to allow behavioral health services provided in a 
public school setting to be classified and reimbursed as community-based services.
Sec. 4. Timing. Resolved: That the department shall begin the process of amending 
its rules in accordance with this resolve immediately after this resolve becomes effective. 
The rule changes directed by this resolve must remain in effect until the department 
completes a rate determination of the affected rules pursuant to the Maine Revised Statutes, 
Title 22, section 3173-J.
Sec. 5. Formation of stakeholder group and study required. Resolved: That 
the department shall form a stakeholder group to conduct a study to evaluate how to 
develop more sustainable models of outpatient and residential mental and behavioral health 
treatment services and how to increase access to those services within the State. By January 
1, 2025, the stakeholder group shall submit a report of the study to the department. By 
January 15, 2025, the department shall submit to the joint standing committee of the 
Legislature having jurisdiction over health coverage, insurance and financial services 
matters a summary of the report based on the stakeholder group's findings and 
recommendations, including suggested legislation. The joint standing committee may 
report out legislation to the 132nd Legislature in 2025 based on the report.
SUMMARY
This resolve directs the Department of Health and Human Services to amend the 
MaineCare rules governing reimbursement for outpatient behavioral health services 
provided in public schools under the MaineCare Benefits Manual, Chapters II and III, 
Section 65 and for services provided in residential treatment facilities for persons with 
mental illness and in specialized or scattered residential treatment facilities as described in 
the MaineCare Benefits Manual, Chapter III, Section 97, Appendices E and F, respectively. 
The department must initiate the rule-making process immediately after the resolve goes 
into effect, and the rules must remain in effect until the department completes a full rate 
determination. Finally, the resolve requires the department to form a stakeholder group to 
study how to develop more sustainable models of outpatient and residential mental and 
behavioral health treatment services and how to increase access to those services within the 
State. By January 1, 2025, the stakeholder group must submit a report to the department, 
and by January 15, 2025, the department must submit to the joint standing committee of 
the Legislature having jurisdiction over health coverage, insurance and financial services 
matters a summary of the report based on the stakeholder group's findings and 
recommendations, including suggested legislation. The joint standing committee is 
authorized to report out legislation.