CHAPTER 459
S.P. 48 - L.D. 125
An Act to Promote Fairness and Opportunity for Working Amputees
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4315 is enacted to read:
§4315. Coverage of prosthetic devices
1. Definition. As used in this section, "prosthetic device" means an artificial device to replace, in whole or in part, an arm or a leg.
2. Required coverage. A carrier shall provide coverage for prosthetic devices in all health plans that, at a minimum, equals the coverage and payment for prosthetic devices provided under federal laws and regulations for the aged and disabled pursuant to 42 United States Code, Sections 1395k, 1395l and 1395m and 42 Code of Federal Regulations, Sections 414.202, 414.210, 414.228 and 410.100. Covered benefits must be provided for a prosthetic device determined by the enrollee's provider, in accordance with section 4301-A, subsection 10-A, to be the most appropriate model that adequately meets the medical needs of the enrollee.
3. Prior authorization. A carrier may require prior authorization for prosthetic devices in the same manner as prior authorization is required for any other covered benefit.
4. Repair or replacement. Coverage under this section must also be provided for repair or replacement of a prosthetic device if repair or replacement is determined appropriate by the enrollee's provider.
5. Coverage under managed care plan. If coverage under this section is provided through a managed care plan, a carrier may require that prosthetic services be rendered by a provider who contracts with the carrier and that a prosthetic device be provided by a vendor designated by the carrier.
6. Exclusions. Coverage is not required pursuant to this section for a prosthetic device that contains a microprocessor or that is designed exclusively for athletic purposes.
Sec. 2. Application. The requirements of this Act apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2004. For purposes of this Act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
Effective September 13, 2003, unless otherwise indicated.
| Revisor of Statutes Homepage | Subject Index | Search | 121st Laws of Maine | Maine Legislature |
