HP0488, LD 716, item 1, An Act Regarding Prescription Medications for Children under the MaineCare Program

An Act Regarding Prescription Medications for Children under the MaineCare Program

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA §3174-WW is enacted to read:

§ 3174-WW. Program regarding prescription medications for children

The department shall adopt a program regarding prescription medications for children that consists of a prescription medication protocol, prescription medication monitoring and prior authorization for reimbursement under the MaineCare program. The program must ensure that children have access to medically needed prescription medications in compliance with the requirements of this section and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services.

1. Stimulant drugs. The program must include coverage for medications classified as stimulants in accordance with the prescribing guidelines for various age ranges established by the American Academy of Pediatrics and must include, but not be limited to, training for caregivers in behavioral therapy in order to increase the effectiveness of treatment. The program must include monitoring to ensure that children who are prescribed stimulants have been properly diagnosed and are monitored on an ongoing basis for effectiveness and side effects and to determine whether adjustments are required to maintain the balance between the benefits and side effects of the stimulants.

2. Stimulant drugs and benzodiazepine drugs. The program must include a protocol to ensure that children who are prescribed a stimulant drug and a benzodiazepine drug concurrently are reviewed and monitored on an ongoing basis for appropriateness and effectiveness of the combined drugs. The protocol must include the provision of educational materials to parents and caregivers that cover appropriateness of use, potential side effects, ongoing monitoring to determine effectiveness, necessity of managing behavior and the effectiveness of combining behavioral therapy with medication. The protocol must include a prior authorization process for continued concurrent use beyond 3 months. Prior authorization must be based on clinically valid studies justifying the concurrent use of the drugs for the diagnosis of the child and the applicable time period.

summary

This bill directs the Department of Health and Human Services to adopt a program regarding prescription medications for children that consists of a prescription medication protocol, monitoring and prior authorization for reimbursement under the MaineCare program. The program must ensure that children have access to medically needed prescription medications in compliance with the requirements of this bill and the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services.

HP0488 LD 716	Session - 126th Maine Legislature		LR 1156 Item 1
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