Amend the bill in section 1 in subsection 4-A in the 2nd line (page 1, line 4 in L.D.) by inserting after the following: " health condition" the following: ' , including severe pain,'
Amend the bill in section 1 in subsection 4-A in paragraph A in subparagraph (2) in the first line (page 1, line 13 in L.D.) by inserting after the following: " function;" the following: ' or'
Amend the bill in section 1 in subsection 4-A in paragraph A by striking out all of subparagraph (4) (page 1, line 15 in L.D.).
Amend the bill in section 1 in subsection 4-B in the last line (page 1, line 23 in L.D.) by striking out the following: " by a health care provider"
Amend the bill by striking out all of sections 2 and 3 and inserting the following:
‘Sec. 2. 24-A MRSA §4304, sub-§5, as enacted by PL 1999, c. 742, §13, is amended to read:
Sec. 3. 24-A MRSA §4320-C, as enacted by PL 2011, c. 364, §34, is amended to read:
If a carrier offering a health plan subject to the requirements of the federal Affordable Care Act provides or covers any benefits with respect to services in an emergency department of a hospital facility or setting, the plan must cover emergency services in accordance with the requirements of the federal Affordable Care Act, including requirements that emergency services be covered without prior authorization and that cost-sharing . Cost-sharing requirements, expressed as a copayment amount or coinsurance rate, for out-of-network services are the same as requirements that would apply if such services were provided in network. A carrier offering a health plan in this State shall also comply with the requirements of section 4304, subsection 5.
Sec. 4. Rulemaking. Notwithstanding the Maine Revised Statutes, Title 24-A, section 4309, any rules adopted by the Department of Professional and Financial Regulation, Bureau of Insurance to amend rule Chapter 850: Health Plan Accountability as necessary to conform to this Act are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.’
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section number to read consecutively.
SUMMARY
This amendment makes several changes to the bill.
1. It removes the reference to inadequately controlled pain and uses the phrase "severe pain" to maintain consistency with the definition used in the federal Patient Protection and Affordable Care Act.
2. It clarifies the definition of "emergency service" so that it applies to services provided in an emergency setting or facility and makes other changes to maintain consistent language within the definition.
3. It removes the reference to prior authorization for emergency services in section 2 of the bill because it is redundant with changes made in section 3.
4. It clarifies that before a carrier denies benefits or reduces payment for an emergency service based on a determination of the absence of an emergency medical condition or a determination that a lower level of care was needed, the carrier's utilization review must be done by a board-certified emergency physician who is licensed in this State and that the review must include a review of the enrollee's medical record related to the emergency medical condition subject to dispute.
5. It provides that any rules adopted by the Department of Professional and Financial Regulation, Bureau of Insurance to amend current rules to conform to changes made in this legislation are routine technical rules.