Maine Code § 22-3174-JJJ

Reimbursement for comprehensive sexual and reproductive health care services
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(REALLOCATED FROM TITLE 22, SECTION 3174-III)
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).
[PL 2021, c. 738, §1 (NEW); RR 2021, c. 2, Pt. A, §61 (RAL).]
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.
[PL 2021, c. 738, §1 (NEW); RR 2021, c. 2, Pt. A, §61 (RAL).]
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.
[PL 2021, c. 738, §1 (NEW); RR 2021, c. 2, Pt. A, §61 (RAL).]
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).]

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