An Act to Ensure Treatment for MaineCare Recipients with Serious Mental Illness by Prohibiting the Requirements for Prior Authorization and Step Therapy for Medications
Maine Legislature, Session 131, LD 1428
Committee: Health and Human Services
Sponsors: MADIGAN, BRENNER, CRAFTS, GRAMLICH, SHAGOURY
Amends: 22 MRSA §3174-K

Legislative Document
No. 1428
H.P. 924
House of Representatives, March 30, 2023
An Act to Ensure Treatment for MaineCare Recipients with Serious 
Mental Illness by Prohibiting the Requirements for Prior 
Authorization and Step Therapy for Medications
(EMERGENCY)
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MADIGAN of Waterville.
Cosponsored by Senator BRENNER of Cumberland and
Representatives: CRAFTS of Newcastle, GRAMLICH of Old Orchard Beach, SHAGOURY of 
Hallowell.
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 is needed to immediately remove the requirements for prior 
authorization and step therapy for medications used to treat serious mental illness, 
requirements that create unnecessary and potentially devastating interruptions in patient 
care and unnecessary burdens for health care providers and that have the unintentional 
effect of more costly and catastrophic outcomes; 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 §3174-KKK is enacted to read:
§3174-KKK.  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 Diagnostic and 
Statistical Manual of Mental Disorders published in 2022 by the American Psychiatric 
Association that results in serious functional impairment that substantially interferes 
with or limits one or more major life activities. 
B. "Step therapy protocol" means a protocol or tiered program that establishes a 
specific sequence in which prescription drugs for a specified medical condition are 
medically necessary for a particular MaineCare member and are covered under this 
chapter, including self-administered and physician-administered drugs. 
2.  Prior authorization or step therapy protocol. The department may not require 
under the MaineCare program prior authorization or a step therapy protocol for prescription 
drugs used for the assessment or treatment of serious mental illness, except that the 
department may impose a prior authorization requirement for a dosage increase that 
exceeds the department's dosing criteria as identified on the department's MaineCare 
preferred drug list.
3.  Medicaid. The implementation of this section and rules adopted pursuant to this 
section must be consistent with the requirements of the Medicaid drug rebate program.
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.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
SUMMARY
This bill prohibits prior authorization requirements and step therapy protocols under 
the MaineCare program for prescription drugs used to assess or treat serious mental illness. 
The implementation of the prohibition must be consistent with the requirements of the 
Medicaid drug rebate program.