AUGUSTA, Maine — Proposed changes to state rules for how methadone and Suboxone clinics serve Medicaid recipients threaten to drive some of those clinics out of business in the midst of an unprecedented addiction crisis in Maine, advocates for medication-assisted treatment testified Monday.

The draft rules, proposed recently by the Maine Department of Health and Human Services, would introduce new requirements for medication-assisted treatment facilities that disburse methadone and Suboxone, medications that are used to help people with opioid addictions kick their habits.

The proposed rules, which would have to be approved by the federal government, include new paperwork requirements, new requirements for medical directors at the clinics and new dosage limits, among other elements. The rules come on the heels of the state lowering Medicaid reimbursement rates for methadone clinics from $72 per patient per week to $60 per patient per week in 2012.

“As methadone providers look at this rule, we appreciate the underlying intent that is aimed at the quality of the services provided,” Jim Cohen, a lobbyist who represents methadone providers, said. “These rules could exacerbate the crisis. [That risk] is not a small one because providers are operating on the edge of financial viability today.”

Not all of the rules would negatively affect clinics, Cohen said. The rules would ease a requirement that the clinics operate seven days a week by letting them be open only six days per week.

Cohen said during a sparsely attended public hearing Monday that the big issue is asking clinics to provide more services without increasing reimbursement rates. A bill to increase the reimbursement rate passed with bipartisan legislative support earlier this year but died when no funding was appropriated.

DHHS said during testimony on that bill that it would study reimbursement rates for clinics and forward recommendations by this fall, according to Cohen.

“We would strongly encourage that the brakes be put on this process so it can be done in conjunction with the rate-setting process,” Cohen said.

A DHHS spokeswoman did not respond to questions posed by the BDN after the hearing.

Another concern for clinics is that the new Medicaid rules would be at odds with licensing requirements that are elsewhere in Maine law.

Cohen said clinics received no direct notice of the rule change proposals nor any indication that a rate study is underway.

“If the goal is that we want more services as a state, it has to be balanced with a fair reimbursement rate,” said Cohen, who was one of only two people who testified on Monday. The other was Jack Comart of Maine Equal Justice Partners, which advocates for low-income Mainers. He said his organization’s advocacy will focus on preserving access to treatment for people fighting addiction.

“It’s become increasingly difficult over the years for our clients to get medication-assisted treatment because of some of the changes in policy that have been made,” Comart said. “I don’t understand why in the middle of this drug crisis the department is taking steps that would make it more difficult for people to obtain this service rather than making it more accessible.”

Public comments on the proposed rule will be accepted until July 21.

Christopher Cousins

Christopher Cousins has worked as a journalist in Maine for more than 15 years and covered state government for numerous media organizations before joining the Bangor Daily News in 2009.