Maine § 3174-JJJ. - Reimbursement for comprehensive sexual and reproductive health care services

§ 3174-JJJ.. Reimbursement for comprehensive sexual and reproductive health care services

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); RR 2021, c. 2, Pt. A, §61 (RAL).]

1.  Definition.  For purposes of this section, "sexual and reproductive health care provider" means an enrolled MaineCare provider engaged primarily in the delivery of services described in 42 United States Code, Section 1396d(a)(4)(C).

2.  Comprehensive sexual and reproductive health care services payment.  The department shall determine and pay each sexual and reproductive health care provider an amount based on the total number of MaineCare-covered patient encounters per month, to include patient encounters taking place on or after July 1, 2022. The payment must include compensation for the difference between the payment for services described in subsection 1 and 100% of the reasonable costs of operation, including without limitation the costs of all services. In determining the payment, the department may exclude only those incremental operating costs directly attributable to specific items and services that federal law explicitly prohibits Medicaid programs from reimbursing. The payment required by this subsection must be made for all encounters with a sexual and reproductive health care provider by any MaineCare member, regardless of the category or other basis for the member's eligibility for MaineCare coverage.

3.  Rulemaking.  The department shall 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.

The department shall pursue all opportunities to maximize available federal reimbursement, including available Medicaid match rates for or other opportunities to maximize state resources for family planning services.   [PL 2021, c. 738, §1 (NEW); RR 2021, c. 2, Pt. A, §61 (RAL).]