Rule Adoption: Maine State Services Manual, Section 7, Abortion Services for MaineCare Services

 

Notice of Agency Rule-making Adoption

 

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 Services

 

ADOPTED RULE NUMBER:

 

CONCISE SUMMARY: The Department adopts this final rule which implements P.L. 2019, ch. 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 rulemaking authority to implement these services on an emergency basis, per 5 M.R.S. § 8054. The Department filed the emergency rule on September 19, 2019. This routine technical rulemaking permanently adopts the rule.

 

The Department modified the final rule in Section 7.05, Covered Services, subsections A and D by changing the term “physician” to “Health Care Professional” to comply with P.L. 2019, ch. 262, as codified in 22 M.R.S. § 1596, which broadened the Maine abortion law to include physician assistants and advanced practice registered nurses as qualified professionals authorized to perform abortions.

 

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

 

EFFECTIVE DATE:                          December 17, 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) 287-6106

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