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An Act To Improve Access to Services for Adults with Serious and Persistent Mental Illness
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  34-B MRSA §3613  is enacted to read:
§ 3613. Access to services
 
1.  Department review.     An adult with serious and persistent mental illness, as defined in rules adopted by the department pursuant to this section, who is receiving or is eligible to receive mental health services from a provider operating an agency, facility or program under contract with the department may seek department review of the provider's actions in the following circumstances:
 
A.  When the provider refuses to accept a referral to provide a mental health service for which the adult is clinically eligible that is included in rules of the department governing the MaineCare program or otherwise required to be provided under the terms of the provider's contract with the department and that the adult's treatment or discharge planning team has determined is necessary in order for that adult to transition from a hospital into the community, unless accepting the referral would cause the provider to exceed preestablished staff-client ratios required by law, rule or contract or unless the service is a residential service and the provider has no vacancies;
 
B.  When the provider refuses to accept a referral to provide community integration services or assertive community treatment as defined in section 3801, subsection 11 to an adult with serious and persistent mental illness who is clinically eligible for the services, unless accepting the referral would cause the provider to exceed preestablished staff-client ratios required by law, rule or contract; or
 
C.  When the provider terminates or suspends a mental health service included in rules of the department governing the MaineCare program or otherwise required to be provided under the terms of the provider's contract with the department in violation of the terms of that contract.
 
2.  Private right of action.     An adult with serious and persistent mental illness who is aggrieved by the action of a provider as described in subsection 1 and whose access to services has not been resolved following department review may bring a private civil action in District Court to restrain or enjoin a provider by restraining order or injunction, temporarily or permanently, or enforce by restraining order or injunction, temporarily or permanently, the terms of the provider's contract with the department.
 
A.  An individual bringing an action under this subsection is not required to allege or prove that the refusal, termination or suspension of services would cause irreparable injury or harm to that individual.
 
B.  An individual bringing an action under this subsection is not required to post a bond.
 
C.  The remedies available in an action under this subsection include both mandatory and prohibitory injunctive relief.
 
D.  An individual who obtains injunctive relief in an action under this subsection may recover reasonable attorney's fees and costs, not to exceed $1,000, from the provider against whom judgment was entered.
 
E.  An individual who brings an action under this subsection is not liable to the provider for damages resulting from bringing or pursuing the action unless the action was brought in bad faith or without a reasonable belief that the provider was not acting in compliance with its obligations under its contract with the department.
 
3.  Rulemaking.     The department shall adopt rules, which are routine technical rules pursuant to Title 5, chapter 375, subchapter 2-A, governing the process for department review described in this section. The rules must include a definition of "adult with serious and persistent mental illness."
 
SUMMARY
This bill establishes the right of an adult with serious and persistent mental illness who is denied access to services by a provider contrary to the terms of the provider's contract with the Department of Health and Human Services to seek department review of that action. If department review does not resolve the matter, the consumer may bring a private right of action in District Court for injunctive relief.