Emergency Adopted Rule: 10-144 C.M.R., Chapter 104, Maine State Services Manual, Section 7, Abortion Services for MaineCare Members

Notice of Agency Rule-making Adoption

EMERGENCY RULE

 

AGENCY: Department of Health and Human Services, Office of MaineCare Services

 

CHAPTER NUMBER AND TITLE:  10-144 C.M.R., Chapter 104, Maine State Services Manual, Section 7, Abortion Services for MaineCare Members

 

ADOPTED RULE NUMBER:

 

CONCISE SUMMARY:

 

This emergency rulemaking implements P.L. 2019, c. 274, An Act to Prevent Discrimination in Public and Private Insurance Coverage for Pregnant Women in Maine (the “Act”), which requires state-funded coverage for abortion services to MaineCare members when those services are not covered by Medicaid.

 

Federal law limits Medicaid reimbursement to those abortions necessary to protect the life of the mother, or when the pregnancy results from rape or incest (the “Hyde Exceptions.”). See, e.g., 42 C.F.R. §§ 441.200-441.208; 10-144 C.M.R. Ch. 101 (the “MaineCare Benefits Manual”), Ch. II, Sec. 90.05-2 (MaineCare rule implementing Hyde Exceptions). The Act requires that, for MaineCare eligible women, abortion services that are outside the Hyde Exceptions (i.e., not covered Medicaid services) must be funded separately by using state funds within existing resources. The Legislature appropriated from the General Fund approximately $227,546 and $375,843, respectively, for the next two fiscal years to provide these new state only funded abortion services. See the Act, Sec. 10 (Appropriations and allocations). The Department requires providers to identify state-funded abortion services when submitting claims for reimbursement of state funded abortion services. This allows the Department to distinguish the state funded abortion claims from those that are covered under the Hyde Exceptions, in order to maintain compliance with federal Medicaid restrictions and requirements for reimbursement.

 

Pursuant to the Act, the Legislature provided the Department with authority to implement these services on an emergency basis, per 5 M.R.S. § 8054, without the necessity of demonstrating that immediate adoption is necessary to avoid a threat to public health, safety, or general welfare. Emergency rules are effective immediately and valid for ninety days. The Department shall hereafter initiate “regular” routine technical proposed rulemaking to implement this rule permanently.

 

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

 

EFFECTIVE DATE:                         September 19, 2019

 

AGENCY CONTACT PERSON:    Anne E. Labonte, Comprehensive Health Planner II

AGENCY NAME:                             Division of Policy

ADDRESS:                                         109 Capitol Street

                                                             11 State House Station

                                                             Augusta, Maine 04333-0011

EMAIL:                                              Anne.Labonte@Maine.gov

TELEPHONE:                                  (207)-624-4082 FAX: (207) 287-1606