An Act To Clarify Insurance Coverage in School-based Health Centers
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4316-A is enacted to read:
§ 4316-A. Coverage of services provided by federally qualified health center in schools
1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Federally qualified health center" means a center that provides preventive primary health care services and is receiving a grant under Section 330 of the federal Public Health Service Act, 42 United States Code, Section 254b.
B. "School-based health center" is a facility located in a school building or on school grounds in this State that provides comprehensive primary health care services.
2. Coverage. A carrier offering a health plan in this State may not deny coverage on the basis that the coverage is delivered in a school-based health center operating under a contract with a federally qualified health center if the health care service would be covered if it were provided in the federally qualified health center. Coverage for health care services provided in a school-based health center must be determined in a manner consistent with coverage for health care services provided in a federally qualified health center. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided in a school-based health center as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to services provided in a federally qualified health center.
SUMMARY
This bill prohibits health insurance carriers from denying coverage for services delivered in a school setting under a contract with a federally qualified health center if the same services would be covered if provided at the federally qualified health center.