State Overview: Maine

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

Prior authorization is prohibited for at least one medication in each therapeutic class of medication assisted treatment (MAT) medications for opioid use disorder (OUD) and for MAT for OUD for pregnant women (medications + counseling). MAT includes counseling. Maine Rev. Stat. Ann. tit. 24-A, §4304,-A(2)

Maine credentials two types of addiction counselors. A Certified Alcohol and Drug Counselor requires a high school diploma, 30 semester hours of relevant coursework and 4,000 hours of experience. A Licensed Alcohol and Drug Counselor credential can be achieved with a CADC credential and 2,000 more hours of experience. If individuals do not have a qualifying degree or only have a high school, they need 6,000 hours experience. Maine Rev. Stat. Ann. tit. 32 §81-6203 and Maine Board of Alcohol and Drug Counselors

Licensed professional counselors (LPCs) are explicitly prohibited from diagnosing patients. LPCs practice the principles and procedures of counseling to assist those served in achieving more effective personal, emotional, social, educational and vocational development and adjustment. Me. Code of Regs. §02.514 Chapter 2.1

The certification standards and procedures for intentional peer support specialists are developed and administered by the state's Office of Substance Abuse and Mental Health Services. The standards for intentional peer support specialists include minimum qualifications, training, continuing education and employment requirements.

Full independent practice and prescriptive authority.

The CNM may provide only those health care services for which the certified nurse midwife is educationally and clinically prepared and for which competency has been maintained. The CNM is authorized to function to the full extent of the midwife education, training and competency within the population focus and scope of practice.

NMs may prescribe prescription drugs and Schedules II-V controlled substances once registered with the U.S. Drug Enforcement Administration. Me. Code of Regs. §02.380.008

Transition to independent practice and prescriptive period required. Before independent practice and prescriptive authority is granted, an NP must practice for at least 24 months under the supervision of a licensed physician. Maine Rev. Stat. Ann. tit. 32 §2102

NPs may prescribe prescription drugs and Schedules II-V controlled substances once registered with the U.S. Drug Enforcement Administration. Maine Code of Regs. §02.380.008 Section 7

NPs are authorized to sign POLST forms. Me. Rev. Stat. Ann. tit. 18, §5-802

NPs are recognized in state policy as primary care providers. Primary care provider means a physician, or a nurse practitioner or physician assistant under the supervision of a physician, under contract with a managed care plan to supervise, coordinate and provide initial and basic care to plan patients, maintain continuity of patient care, and initiate patient referrals for specialist care. Me. Code of Regs. §02.031.850.5(FF)

Physician relationship required for practice and prescriptive authority, unless the CRNA is practicing at a critical access or rural hospital. Transition to prescriptive period required.

“A CRNA is responsible and accountable to a licensed physician or dentist for aspects of anesthesia practice that require execution of the medical regimen as prescribed by that physician or dentist,” unless practicing at a critical access or rural hospital. Me. Rev. Stat. Ann. tit. 32 §2211(3)(E)

“In a critical access hospital or a hospital located in a rural area, the CRNA may, in accordance with the bylaws and policies of the facility in which the CRNA is practicing, formulate and implement a patient-specific plan for anesthesia care.” Me. Code of Regs. §02.380.008 Section 6 and Section 7(1)(C)

Transition to prescriptive period required. Before CRNAs are granted prescriptive authority, they must meet certain requirements found in Me. Code Regs. §02.380.008 Section 6

In critical access hospitals or rural hospitals, CRNAs may prescribe prescription drugs and Schedules II-V controlled substances once registered with the U.S. Drug Enforcement Administration and under certain conditions. Conditions include prescribing a limited supply with no prescription refills only to patients with established care with the CRNA and having a DEA-issued number registered under a verified critical access or rural hospital address. Me. Code of Regs. §02.380.008 Section 7(C)

Optometrists may only examine, diagnose and treat conditions of the visual system. Maine Rev. Stat. Ann. tit. 32, §2411(1)

Optometrists may only administer an epinephrine autoinjector for treatment of anaphylaxis. Maine Rev. Stat. Ann. tit. 32, §2411(5)

Optometrists may prescribe Schedule III-V controlled substances. Maine Rev. Stat. Ann. tit. 32, §2411(5)

After attaining certain educational and experience levels, a dental hygienist may become an independent practice dental hygienist and practice without the supervision of a dentist. Under Maine scope of practice law, a public health dental hygienist practices in a public health setting and under a supervision agreement with a dentist. Me. Rev. Stat. Ann. tit. 32 §18345 and Maine Rev. Stat. Ann. tit. 32 §18375.

Dental therapists must practice under the direct supervision of a dentist in limited practice settings. A written practice agreement must outline the services that the dental hygiene therapist is authorized to perform under direct supervision. The practice agreement must also outline the protocols for administering and dispensing medications. Maine Rev. Stat. Ann. tit. 32 §18377.

Teledentistry means the use of interactive, real-time visual, audio or other electronic media for the purposes of education, assessment, examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by individuals licensed under this chapter and includes synchronous encounters, asynchronous encounters, remote patient monitoring and mobile oral health care in accordance with practice guidelines specified in rules adopted by the board. Maine Rev. Stat. Ann. tit. 32 §18394

Pharmacists may administer and order the COVID-19 vaccine to a person 3 years of age or older. Maine Rev. Stat. Ann. tit. 32 §13831

Pharmacists may modify prescriptions with therapeutically equivalent drugs or interchangeable biological product. The pharmacist must inform the patient of the substitution and enter the medication change into the electronic records system within five days of dispensing. Maine Rev. Stat. Ann. tit. 32 §13781

Pharmacists can prescribe, dispense or administer a self-administered hormonal contraceptive or injectable hormonal contraceptive. Maine Rev. Stat. Ann. tit. 32 §13826-2

Pharmacists may prescribe nicotine replacement products pursuant to a written protocol approved by the Board of Pharmacy. Maine Rev. Stat. Ann. tit. 32 §13792-A-28

Collaboration allowed with a physician for practice and prescriptive authority.

A PA may provide any medical service for which the PA has been prepared by education, training and experience and is competent to perform.

"Collaborative agreement" means a document agreed to by a PA and a physician that describes the scope of practice for the PA as determined by practice setting and describes the decision-making process for a health care team, including communication and consultation among health care team members. Maine Rev. Stat. tit. 32 § 3270-G(1)(A)

A PA who dispenses a prescription or legend drug shall comply with all relevant federal and state laws and federal regulations and state rules. They may dispense the prescription or legend drug only when: a pharmacy service is not reasonably available, dispensing the drug is in the best interest of the patient, or an emergency exists. Maine Rev. Stat. tit. 32 § 3270-G(3)

Maine does not currently have a provision related to the number of PAs a physician can supervise.

Maine does not currently have any provisions related to chart review and co-signatures.

Statute allows adaptable proximity.

PAs shall, as indicated by a patient's condition, the education, competencies and experience of the PA and the standards of care, consult with, collaborate with or refer the patient to an appropriate physician or other health care professional. The level of consultation required is determined by the practice setting, including a physician employer, physician group practice, or private practice, or by the system of credentialing and granting of privileges of a health care facility. A physician must be accessible to the PA at all times for consultation. Consultation may occur electronically or through telecommunication and includes communication, task sharing and education among all members of a health care team. Maine Code Regs. § 02-383 ch. 2 sec. 6

Physician assistant scope of practice is delineated in collaborative agreements or practice agreements that are subject to review and approval by the board. Maine Code Regs. §02-373 ch. 2 sec. 3