MaineCare Policy Adoption - Ch. II, Section 55, Laboratory Services - November 9, 2016

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage.  This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes.  The MaineCare Benefits Manual is available on-line at the Secretary of State’s website. 

Below, please find a Notice of Agency Rule-making Adoption.  You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml

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               Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

                     CHAPTER NUMBER AND TITLE:  10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Section 55, Chapter II, Laboratory Services

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  This rule was adopted to limit and align urine drug testing to current industry standards. The Department adopted the following from the proposed rule:

• Drug testing must be supported by documentation in the medical record.
• The frequency and choice of assay used should be based on an assessment of the individual member’s risk potential.
• Separate payment for testing of adulterants or specimen validity is not reimbursable.
• Substance abuse treatment is to be measured by random testing rather than scheduled testing.
• Routine urine drug screening should focus on detecting specific drugs of concern.
• Standing orders for presumptive testing must be signed and dated no more than sixty (60) days prior to the date of specimen collection. Standing orders for conformation and/or quantitative testing is prohibited.
• The Department clarifies what is considered not medically necessary.
• The Department added language for Prior Authorization to the Definitions.

The Department made the following changes to the final rule based on public comments:

• Confirmation testing is covered only to:

1. Confirm an unexpected result; or
2. Identify specific drugs or metabolites that cannot be detected on a urine drug screen.

Confirmation tests should be based on the member’s presentation and history and only include what is needed for safe patient management. The definitive test(s) must be supported by documentation that specifies the rationale for each definitive test ordered. Drug confirmation testing must be performed by a second method. A presumptive test cannot be performed to confirm a presumptive test. Confirmation testing must be requested in writing by the ordering provider.

• Urine drug testing is limited to three (3) specimens per rolling month. Additional test(s) may be requested with a Prior Authorization to be issued in six (6) month authorizations. Individuals meeting the following criteria are exempt from this limitation, and are not required to seek Prior Authorization for testing beyond three (3) specimens per month:

1. Pregnant members;
2. Members involved with an active Office for Child and Family Services (OCFS) case;
3. Members in Intensive Outpatient Treatment (IOP);
4. Members being established in Medicated Assistant Treatment (MAT) up to six months (including methadone, suboxone, and other MAT treatments);
5. Members receiving services in an Emergency Department; and
6. Members in Residential Treatment for substance abuse (Chapter 97 Appendix B facilities)

• The Department removed the limit of reflex testing by the lab based on standing order.
• The Department removed the limit of urine drug testing for the courts.
• Finally, the Department made minor clerical edits to the final rule.

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

 EFFECTIVE DATE:                        November 9, 2016                  

AGENCY CONTACT PERSON:    Cari Bernier, Comprehensive Health Planner

AGENCY NAME:                             Division of Policy

ADDRESS:                                        242 State Street

                                                            11 State House Station

                                                             Augusta, Maine 04333-0011

                         Email: Cari.Bernier@maine.gov

TELEPHONE:                                   (207)-624-4031 FAX: (207) 287-1864

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