Title 22, Title 22

1. Authorization required. The department may not require any MaineCare member to make any payment toward the cost of a MaineCare service unless that payment is specifically authorized by this section, except that any copayment or premium expressly approved by the federal Secreta…

The department shall provide reimbursement, to the maximum extent allowable, under the United States Social Security Act, Title XIX, for substance use disorder treatment. Treatment must include, but need not be limited to, residential treatment and outpatient care as defined in T…

When determining eligibility for Medicaid, the department shall establish ownership of joint bank accounts in accordance with Title 18‑C, section 6‑211, subsection 2. If the department determines that funds were withdrawn from a joint account without the consent of the applicant …

1. Premiums. The department may apply to the federal Centers for Medicare and Medicaid Services for a waiver or amend a pending or current waiver under the Medicaid program authorizing the department to impose cost sharing on some or all persons eligible for MaineCare under the K…

1. Family planning benefit. The department shall provide for the delivery of federally approved Medicaid services to a qualified adult or adolescent whose individual income is equal to or below 209% of the nonfarm income official poverty line for reproductive health care and fami…

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Asynchronous encounters" means the interaction or consultation between a patient and the patient's provider or between health professionals regard…

The Maine Telehealth and Telemonitoring Advisory Group, as established by Title 5, section 12004‑I, subsection 38‑A and referred to in this section as "the advisory group," is created within the department. [PL 2017, c. 307, §3 (NEW).] 1. Membership. The advisory group consists o…

This section establishes a rate-setting system for the development and maintenance of MaineCare payment models and rates that comply with the requirement in 42 United States Code, Section 1396a that rates be consistent with efficiency, economy and quality of care; that are adequa…

To promote public health and the health of MaineCare members, the department may authorize standing orders for the dispensing of vaccines as described in Title 32, section 13831 and nonprescription drugs as defined in Title 32, section 13702‑A, subsection 20 that support access t…

Medical indigency and eligibility for assistance under this chapter are to be defined and determined in manners consistent with the requirements for the receipt of federal matching funds under Title XIX, or its successors, of the Social Security Act. [PL 1977, c. 714, §3 (NEW).] …

The department shall administer a program of medical coverage for persons residing in cost reimbursement boarding homes who, but for their income, would be eligible for supplemental security income benefits on account of blindness, disability or age, and who do not have sufficien…

Beginning January 1, 2002, in determining eligibility for medical assistance under the Medicaid program for all individuals and families subject to an asset test, the department shall exempt from consideration all assets exempt pursuant to program rule on January 1, 2001 and shal…

1. Special report. The commissioner shall prepare an annual report detailing all receipts and expenditures in the Medicaid program for the prior year and proposals for the coming year. A. This document shall include, but not be limited to, the following information: A listing of …

The department shall establish enrollment periods for medical assistance as provided in this section. Prior to the end of the enrollment period, the department shall determine continuing eligibility for the next enrollment period and notify the enrollee of the determination. [PL …

Notwithstanding any other provision of law to the contrary, a parent receiving benefits under this chapter as a parent of one or more dependent minor children who have been removed from the home of that parent pursuant to section 4036‑B continues to be eligible for benefits under…

Provided that the federal maintenance-of-effort requirements are satisfied, the department shall provide reimbursement, under the United States Social Security Act, Title XIX, for inpatient psychiatric facility care and treatment of patients with mental diseases.

1. Establish procedures. The department shall establish procedures to ensure that: A. A person receiving federally approved Medicaid services prior to incarceration in a correctional facility, county jail or regional jail does not lose Medicaid eligibility as a result of that inc…

1. (TEXT EFFECTIVE UNTIL CONTINGENCY: See PL 2023, c. 454, §4) Reimbursement. The department shall reimburse under the MaineCare program for chiropractic evaluation and management examinations performed by a chiropractic doctor licensed under Title 32, chapter 9 that are within t…

The Department of Health and Human Services may administer a program of Medicaid coverage for speech and hearing services, psychological services, occupational therapy and any other services provided by the Maine Educational Center for the Deaf and Hard of Hearing and the Governo…

The department may contract with one or more health insurance carriers or the Dirigo Health Self-administered Plan established pursuant to Title 24‑A, section 6981 to purchase Dirigo Health Program coverage for MaineCare members who seek to enroll through their employers pursuant…

The department may not provide MaineCare reimbursement for conversion therapy as defined in Title 32, section 59‑C, subsection 1 administered to a minor.

The department, with the approval of the Governor and on behalf of the State, may enter into an agreement with the United States Social Security Administration for the purpose of receiving reimbursement for interim assistance payments as provided by the United States Social Secur…

The department shall require MaineCare members to purchase maintenance drugs by mail order when substantial cost efficiencies can be obtained by doing so. Any savings measures implemented by the department in fiscal year 2003-04 that are of a temporary nature may remain in effect…

1. Medication-assisted treatment. For the purposes of this section, "medication-assisted treatment" means an evidence-based practice that combines pharmacological interventions with substance use disorder counseling. 2. Prior authorization limitation. The department may not requi…

1. Coverage provided. The Department of Health and Human Services shall provide the following dental services, reimbursed under the United States Social Security Act, Title XIX, or successors to it, to individuals 21 years of age and over: A. Acute surgical care directly related …

1. Established. The MaineCare Basic program is established to deliver medically necessary health care services to adult members of the MaineCare program. 2. Rules. The department shall adopt rules to implement MaineCare Basic in accordance with this section. Rules adopted pursuan…

1. Coverage provided. Effective July 1, 2022, a person is eligible for the same scope of medical assistance provided under section 3174‑G if the person is a child under 21 years of age who would be eligible for assistance under the federal Medicaid program under Title XIX of the …

1. Delivery of services. The department shall provide for the delivery of federally approved Medicaid services to the following persons: A. A qualified woman during her pregnancy and up to 60 days following delivery when the woman's family income is equal to or below 209% of the …

There is established within the department the Long-term Care Partnership Program pursuant to Section 6021 of the federal Deficit Reduction Act of 2005, Public Law 109-171, 120 Stat. 4 (2006), referred to in this section as "the program," to provide incentives for persons to insu…

1. Reimbursement. The department shall provide reimbursement under the MaineCare program for palliative care for the entire interdisciplinary team as appropriate to the plan of care, regardless of setting, including hospitals, nursing homes, outpatient clinics and home care provi…

Notwithstanding this chapter, for the purpose of determining medical indigency and eligibility for assistance for an individual residing or about to reside in an institution eligible for Medicaid participation under this section, there shall be a presumption, rebuttable by either…

For the purposes of maximizing coverage for prescription drugs for members who are enrolled in the MaineCare program, the department may provide prescription drug services for MaineCare members through the elderly low-cost drug program established under section 254‑D. [PL 2005, c…

Beginning January 1, 2022, the department shall reimburse under the MaineCare program for ostomy equipment and supplies when that equipment or those supplies have been prescribed or recommended by a health care practitioner authorized to prescribe or recommend such equipment or s…

1. Needs assessment. In order to determine the most cost-effective and clinically appropriate level of long-term care services, the department or its designee shall assess the medical and social needs of each applicant to a nursing facility. If the department chooses a designee t…

1. Authorization. To the extent permitted by federal law, with regard to the Medicare Part D benefit established in the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, the department may: A. Serve as an authorized representative…

1. Reimbursement. The department shall provide reimbursement under the MaineCare program for pasteurized donor breast milk provided to an infant receiving benefits under this chapter if a physician or physician associate licensed under Title 32, chapter 36 or 48 or an advanced pr…

The department shall reimburse for ambulance services under MaineCare at a level that is not less than the average allowable reimbursement rate under Medicare for such services or at the highest percent of that level that is possible within resources appropriated for those purpos…

Notwithstanding any provision of law to the contrary, the department shall provide reimbursement for sexual and reproductive health care providers for activities and services to address the health of MaineCare members in accordance with this section. [PL 2021, c. 738, §1 (NEW); R…

By October 1, 1992, the department shall adopt rules to provide Medicaid coverage for crisis counseling for children up to 21 years of age who are in crisis as a result of their removal or imminent removal from their parents' homes. The rules must allow the counseling to be provi…

1. Fund established. The MaineCare Stabilization Fund, referred to in this section as "the fund," is established as an Other Special Revenue Funds account for the purposes specified in this section. 2. Nonlapsing. Any unexpended balances in the fund may not lapse but must be carr…

The department shall reimburse under the MaineCare program for electric breast pumps and supplies without prior authorization or limitation when electric breast pumps or supplies have been prescribed or recommended by a health care professional licensed under Title 32 acting with…

1. Licensed clinical social workers and licensed clinical professional counselors. Licensed clinical social workers must be eligible to receive Medicaid reimbursement for counseling services whenever licensed clinical professional counselors are eligible to be reimbursed for thos…

Beginning April 1, 2010, the Department of Health and Human Services shall begin to phase in a system to reimburse noncritical access hospitals for inpatient services under the MaineCare program an amount per discharge that is based on diagnosis-related groups modeled on the syst…

The department shall administer the Medicare savings program as described in 42 United States Code, Section 1396a(a)(10)(E) in accordance with federal law and with this section. [PL 2023, c. 412, Pt. EEEEE, §4 (NEW).] 1. Asset test. The department may not apply an asset test in d…

1. Authority. The department has the authority to determine which prescription and over-the-counter drugs are subject to reimbursement and coverage under the Medicaid program. 1-A. Formulary standards. Any formulary established by the department must: A. Conform to nationally acc…

Beginning April 1, 2010, the Department of Health and Human Services shall begin to phase in a system to reimburse noncritical access hospitals for outpatient services under the MaineCare program an amount per patient service based on ambulatory payment classifications modeled on…