An Act Regarding the Process for Obtaining Prior Authorization for Health Insurance Purposes
Sec. 1. 24-A MRSA §4304, sub-§2, as amended by PL 1999, c. 742, §12, is further amended to read:
If a carrier does not grant or deny a request for prior authorization within the time frames required under this subsection, the request for prior authorization by the provider is granted.
Sec. 2. 24-A MRSA §4304, sub-§§2-A and 2-B are enacted to read:
Sec. 3. 24-A MRSA §4311, sub-§1-A, ¶A, as enacted by PL 2019, c. 5, Pt. A, §21, is amended to read:
Sec. 4. Rulemaking. The Department of Professional and Financial Regulation, Bureau of Insurance shall amend its rule Chapter 850, Health Plan Accountability:
1. To conform to the changes made in this Act; and
2. To replace the term "urgent care" with the term "exigent circumstances" as used in this Act and to change the timeline for review decisions when exigent circumstances exist to no more than 24 hours after receiving the request.
Notwithstanding the Maine Revised Statutes, Title 24-A, section 4309, any rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 5. Report on electronic transmission of prior authorization request for medical services; authorization to report out legislation. No later than January 1, 2020, health insurance carriers, in cooperation with the Maine Association of Health Plans, shall report to the Joint Standing Committee on Health Coverage, Insurance and Financial Services on efforts to develop standards for secure electronic transmission of prior authorization requests that meet requirements of the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. The committee may report out legislation to the Second Regular Session of the 129th Legislature related to the electronic transmission of prior authorization requests for medical services.