The First Regular Session of the 129th Maine Legislature resulted in a significant number of bills affecting insurance. The following summaries are excerpted in part from summaries prepared by Colleen McCarthy Reid, Office of Policy and Legal Analysis, Legislative Analyst for the Joint Standing Committee on Health Coverage, Insurance and Financial Service.
Unless otherwise noted, the effective date of laws enacted during the First Regular Session is September 19, 2019.
Law/Resolve: Emergency Enacted as Public Law 2019, chapter 5; effective March 19, 2019
Summary of ProvisionsLD 5: An Act To Require Notification of Proposed Rate Increases for Long-term Care Policies
Enacted so that consumer protections related to health insurance coverage in the federal Patient Protection and Affordable Care Act are codified in state law. In Part A, Public Law 2019, chapter 5 does the following:
- Makes clear that carriers in the individual, small group and large group markets must meet guaranteed issue requirements similar to those required by federal law.
- Makes clear that individual and group health plans may not impose any preexisting condition exclusion on an enrollee. The law does permit a carrier to restrict enrollment in individual health plans to open enrollment and special enrollment periods established in rule.
- Clarifies that carriers offering individual or group health plans may not establish lifetime or annual limits on the dollar value of benefits unless the plan is grandfathered under the federal Affordable Care Act as of January 1, 2019 and does not impose new limits or reduce existing limits. The law specifies that the provision prohibiting annual limits on the dollar value of benefits applies to the dollar value of essential health benefits.
- Allows children, until they attain 26 years of age, to remain on their parents' health insurance policy.
- Changes the maximum rate differential due to age that may be filed by the carrier to 3 to 1 and requires that rates that vary based on age do so according to a uniform age rating curve.
- Provides that if a carrier varies premium rates based on family membership, the premium rate must equal the sum of the premiums for each individual in the family.
- Prohibits a carrier from varying premium rates based on tobacco use for individuals who are enrolled in an evidence-based tobacco cessation program approved by the United States Department of Health and Human Services, Food and Drug Administration.
- Makes clear that the minimum medical loss ratio in the individual market is 80% without exception.
- Adds language to prohibit rescissions of coverage consistent with requirements under federal law.
- Makes changes to the timelines and requirements for determinations by a carrier of coverage for prescription drugs consistent with federal law.
- Requires carriers to provide information about the health plans offered by the carrier in a standardized manner that is substantially similar to the manner required for health plans subject to the federal Patient Protection and Affordable Care Act as of January 1, 2019.
- Preserves the authority for certain individuals to purchase coverage under an individual, nonrenewable short-term policy.
Part B requires that, at a minimum, individual and small group health plans cover essential health benefits that are substantially similar to those benefits required for health plans subject to the federal Patient Protection and Affordable Care Act as of January 1, 2019. The law also requires that health plans meet annual limits on cost sharing that are substantially similar to those benefits required for health plans subject to the federal Patient Protection and Affordable Care Act as of January 1, 2019. The law clarifies that pediatric dental benefits may not be required of all individual and small group plans if dental coverage is available in accordance with the federal Affordable Care Act as in effect as of January 1, 2019. Part C adopts nondiscrimination provisions consistent with similar requirements in federal law and rule. Part D makes changes to current requirements in state law related to mental health parity consistent with similar requirements in federal law and regulations.
- Prohibits a health plan from reducing or terminating benefits for an ongoing course of treatment, including coverage of a prescription drug, during the course of an appeal of a determination of coverage.
Law/Resolve: Enacted as Public Law 2019, chapter 25
Summary of ProvisionsLD 38: An Act To Require Insurance Coverage for Hearing Aids for Adults
Enacted as an emergency measure effective March 19, 2019. Changes the time frame for when written notice of a proposed long-term care insurance rate increase must be provided from no later than 10 business days to no later than 30 days after the filing of the proposed premium rate increase. The law clarifies that notice must be provided by the insurer to all affected individual and group policyholders and others who are directly billed for group coverage. The law specifies that the notice must include certain information, including the proposed rate, information on the policyholder's right to request a hearing and submit written comments on the proposed rate and contact information for the Department of Professional and Financial Regulation, Bureau of Insurance. The law also provides that an increase in a premium rate may not be implemented until approved by the bureau or until the effective date of the premium rate increase, whichever is later.
Law/Resolve: Enacted as Public Law 2019, chapter 418; applies to health plans issued or renewed on or after January1, 2020
Summary of ProvisionsLD 249: An Act To Ensure Protection of Patients in Medical Reviews by Health Insurance Carriers
Requires health insurance carriers to provide coverage in all individual and group health plans for hearing aids at a minimum of $3,000 per hearing aid to all individuals with documented hearing loss. The law clarifies that the purchase of a hearing aid must be done in accordance with federal and state laws, regulations and rules for the dispensing of hearing aids.
Law/Resolve: Enacted as Public Law 2019, chapter 171
Summary of ProvisionsLD 260: An Act To Permit Disability Insurance To Be Offered through the Surplus Lines Market
Requires that appeals of a health insurance carrier's adverse health care treatment decision be conducted by a licensed health care practitioner who is board certified in the same or similar specialty as typically manages the medical condition, procedure or treatment under review and whose compensation does not directly or indirectly depend upon the quantity, type or cost of the medical condition, procedure or treatment the practitioner approves or denies on behalf of a carrier.
Law/Resolve: Emergency Enacted as Public Law 2019, chapter 20; effective April 5, 2019
Summary of ProvisionsLD 291: An Act Regarding Responsibility for the Duplicative or Incorrect Payment of Health Insurance Claims
Permits disability insurance to be offered through the surplus lines market. The law allows a licensed producer to place disability insurance through the surplus lines market if coverage is not available from an admitted insurer.
Law/Resolve: Enacted as Public Law 2019, chapter 30
Summary of ProvisionsLD 368: An Act To Redefine Geographic Association for Multiple-employer Welfare Arrangements
Requires a health insurance carrier who has made a duplicative or incorrect payment with respect to health insurance coverage to seek retroactive collection from the provider, not the enrollee, unless the enrollee was already paid directly and the provider submits evidence to the carrier that the enrollee did not forward payment to the provider. A health insurance carrier may require an enrollee to provide evidence of payment to the provider after the provider has first submitted evidence that the enrollee did not forward payment to the provider.
Law/Resolve: Enacted as Public Law 2019, chapter 96
Summary of Provisions
Repeals the provision authorizing a multiple-employer welfare arrangement based on geographic association and removes cross-references to that provision. Authorizes a multiple-employer welfare arrangement by an association with employer members representing multiple trades, industries or professions and restores the ability of the Superintendent of Insurance to authorize a separate community rate for fully insured association health plans for multiple employers.
LD 555: An Act To Reduce Colorectal Cancer Incidence and Mortality by Updating Screening Coverage
Summary of Provisions
Makes the following changes related to medical payments coverage in a casualty insurance policy
- Prohibits a health insurance carrier from coordinating benefits against medical payments coverage in a casualty insurance policy.
- Provides that medical payments coverage is assignable only by agreement between the insured and the casualty insurer.
- Provides that the insured has the right to submit a claim for medical expenses under medical payments coverage in a casualty insurance policy. It also provides that an insured may submit a claim under a health insurance policy, except that an insured is not entitled to duplicate payment from medical payments coverage and a health insurance policy for the same medical expense.
Law/Resolve: Enacted as Public Law 2019, chapter 86
Summary of ProvisionsLD 705: An Act To Ensure Protection of Patients in Medical Reviews by Health Insurance Carriers
Removes references to the age of the patient for purposes of requiring coverage for colorectal cancer screening for asymptomatic individuals who are at average risk for colorectal cancer and instead requires coverage in accordance with the most recently published guidelines of a national cancer society. In addition, the law requires coverage of all colorectal examinations and laboratory tests recommended by a health care provider in accordance with those published guidelines. Applies to health insurance plans issued or renewed on or after January 1, 2020.
Law/Resolve: Enacted as Public Law 2019, chapter 273
Summary of ProvisionsLD 820: An Act To Prevent Discrimination in Public and Private Insurance Coverage for Pregnant Women in Maine
Does the following to amend the prior authorization process for health insurance carriers.
- Reduces the time frame for a carrier's response to a prior authorization request from 2 business days to 72 hours or 2 business days, whichever is less, and clarifies that the same time frame for a response applies in instances when a carrier requests additional information or requires outside consultation. It also provides that a request for prior authorization is granted if a carrier fails to respond within the required time frames.
- Clarifies a provision in existing law to reflect the change in time frame.
- Prohibits a carrier from requiring prior authorization for medication-assisted treatment for opioid use disorder for the prescription of at least one drug for each type of medication used in medication- assisted treatment, except that a carrier may not require prior authorization for medication-assisted treatment for opioid use disorder for a pregnant woman.
- Requires a health insurance carrier to develop an electronic transmission system for prior authorization of prescription drug orders by January 1, 2020.
- Requires health insurance carriers to report, no later than January 1, 2020, 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. It also authorizes the committee to report out legislation to the Second Regular Session of the 129th Legislature related to the electronic transmission of prior authorization requests for medical services.
- Directs the Department of Professional and Financial Regulation, Bureau of Insurance to amend its rules regarding health plan accountability to conform to the statutory changes and designates those rules as routine technical.
Law/Resolve: Enacted as Public Law 2019, chapter 274
Summary of ProvisionsLD 1009: An Act to Provide Protections for Maine Patients Facing Step Therapy
Requires the Department of Health and Human Services to provide coverage to a MaineCare member for abortion services. The law provides that abortion services that are not approved Medicaid services must be funded by the State. The bill also directs the Department of Health and Human Services to adopt rules no later than March 1, 2020 and authorizes the department to adopt rules using the emergency rule-making provisions of the Maine Administrative Procedure Act. Also requires that health insurance carriers that provide coverage for maternity services also provide coverage for abortion services. The law applies this requirement to all health insurance policies and contracts issued or renewed on or after January 1, 2020, except for those religious employers granted an exclusion of coverage. The law authorizes the Superintendent of Insurance to grant an exemption from the requirements if enforcement of the requirements would adversely affect the allocation of federal funds to the State.
Law/Resolve: Enacted as Public Law 2019, chapter 295
Summary of ProvisionsLD 1047: An Act To Prohibit Consideration of Naloxone Purchases in Life Insurance Underwriting
Requires health insurance carriers to establish a process for prescription drug step therapy exceptions. Conforms the timeline for responding to a request for a step therapy override exception determination with the existing timeline for prior authorization requests, clarifies the meaning of exigent circumstances and makes clear that a carrier is required to continue to provide access to the prescription drug subject to step therapy protocol during the consideration of a request for a step therapy override exception determination. Applies to health plans issued or renewed by health insurance carriers on or after January 1, 2020.
Law/Resolve: Enacted as Public Law 2019, chapter 203
Summary of ProvisionsLD 1089: An Act To Ban Discretionary Clauses in Disability Income Insurance Policies
Prohibits a denial or limitation of coverage or an increase in insurance premiums under a life insurance policy based on the fact that an individual has been issued a prescription for naloxone hydrochloride or has purchased naloxone hydrochloride. The law provides an exception to the prohibition when the individual has a demonstrated history of opioid use disorder.
Law/Resolve: Enacted as Public Law 2019, chapter 179
Summary of ProvisionsLD 1155: An Act To Protect Patients and the Prudent Layperson Standard
Prohibits the inclusion or enforcement of a contract provision in individual and group disability income insurance policies allowing the insurer sole or absolute discretion to interpret the insurance contract.
Law/Resolve: Enacted as Public Law 2019, chapter 238
Summary of Provisions Establishes a definition of "emergency medical condition" and "emergency service" in the law governing utilization review in the Maine Insurance Code and makes clear that the determination of an emergency medical condition relies on the prudent layperson standard regardless of the final diagnosis that is given. The law 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. The law also prohibits a carrier from requiring prior authorization for emergency services and requires 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.LD 1162: An Act To Further Expand Drug Price Transparency
Law/Resolve: Enacted as Public Law 2019, chapter 470
Summary of ProvisionsLD 1197: An Act To Amend the Law Prohibiting the Denial by Health Insurers of Referrals by Out-of-network Providers
Requires prescription drug manufacturers to report annually to the Maine Health Data Organization no later than January 30, 2020 and annually thereafter, on prescription drug prices when the manufacturer has during the prior calendar year increased the wholesale acquisition cost of a brand-name drug by more than 20% per pricing unit, increased the wholesale acquisition cost of a generic drug that costs at least $10 per pricing unit by more than 20% per pricing unit or introduced a new drug for distribution in this State when the wholesale acquisition cost is greater than the amount that would cause the drug to be considered a specialty drug under the Medicare Part D program. The law also requires prescription drug manufacturers, wholesale drug distributors and pharmacy benefits managers to provide pricing component data per pricing unit of a drug within 60 days of a request by the Maine Health Data Organization. The law defines "pricing component data" as data unique to each manufacturer, wholesale drug distributor or pharmacy benefits manager that evidences the cost to make a prescription drug available to consumers and the payments received by each manufacturer, wholesale drug distributor or pharmacy benefits manager to make a prescription drug available to consumers, taking into account any price concessions, and that is measured uniformly among the entities, as determined by rules adopted by the organization. The law provides that reported information is confidential, except that information may be shared in the aggregate and with the Department of Professional and Financial Regulation, Bureau of Insurance for enforcement purposes. Beginning November 1, 2020 and annually thereafter, the law requires the Maine Health Data Organization to produce and post on its publicly accessible website an annual report, including information developed from the notifications and disclosures received from prescription drug manufacturers, wholesale drug distributors and pharmacy benefits managers on trends in the cost of prescription drugs, an analysis of manufacturer prices and price increases, the major components of prescription drug pricing along the supply chain and the impacts on insurance premiums and cost sharing and other information the organization determines is relevant to providing greater consumer awareness of the factors contributing to the cost of prescription drugs in the State.
Law/Resolve: Enacted as Public Law 2019, chapter 178
Summary of ProvisionsLD 1260: An Act Regarding Short-term, Limited- duration Health Plans
Provides that the law that prohibits carriers from denying payment for covered health care services solely on the basis that the referral for services was made by an out-of- network provider applies only to referrals made by out-of-network direct primary care providers. It prohibits a carrier from requiring an enrollee to pay a greater cost-sharing amount than the cost-sharing that would apply to the same service if the service was referred by a participating primary care provider. It also allows a carrier to require a direct primary care provider who is not a member of the carrier's provider network to attest that the provider is a direct primary care provider through a written attestation or copy of the direct primary care agreement with the enrollee.
Law/Resolve: Enacted as Public Law 2019, chapter 330
Summary of ProvisionsLD 1261: An Act To Authorize Certain Health Care Professionals to Perform Abortions
Public Law 2019, chapter 330 does the following.
- Limits the issuance of short-term, limited-duration individual health insurance policies in this State to policies with a term that ends on December 31st of the calendar year in which they are issued and allows an insurer or the insurer's agent or broker to issue a short-term, limited-duration policy that replaces a prior short-term, limited-duration policy only if the combined term of the new policy and all prior policies does not exceed 24 months and as long as the individual has not been covered under any short-term, limited-duration policy for at least 12 months prior to the issuance of a policy.
- Requires that insurers make specific written disclosures related to the terms and benefits of policies in at least 14-point type, including the types of benefits and consumer protections that are and are not included in the policies, a summary of plan benefits, limits and exclusions in a standardized format, information about the circumstances in which covered benefits may be subject to balance billing and examples of how charges may be applied toward any cost sharing under the policy and billed to the individual policyholder, and a comparison of the short-term, limited-duration policy to a qualified health plan in the terms, benefits and conditions of the policy, any exclusions, medical loss ratio requirements or the provisions of guaranteed renewal and continuity of coverage. It also requires an insurer to make the documents and information required to be disclosed to be made available on the insurer's publicly accessible website.
- Prohibits a short-term, limited-duration policy from being actively marketed or sold during any open enrollment period except for a policy that terminates coverage on December 31st.
- Restricts the sale of short-term, limited-duration policies to in-person encounters with an insurer or an insurer's agent or broker.
- Requires that an insurer or an insurer's agent or broker, upon offering an individual short-term, limited-duration policy for purchase, assess an individual making an application for eligibility for an advanced premium tax credit or cost-sharing reduction for coverage under a qualified health plan purchased on the exchange pursuant to the federal Patient Protection and Affordable Care Act and provide an estimate of the cost for coverage under a qualified health plan after applying any advanced premium tax credit or cost-sharing reduction.
The requirements of Public Law 2019, chapter 330 apply to policies issued or renewed in this State on or after January 1, 2020.
- Requires the Department of Professional and Financial Regulation, Bureau of Insurance to issue, no later than 30 days following the effective date of this legislation, a bulletin related to short-term, limited-duration health insurance policies describing the statutory requirements for the policies, including the requirements enacted in this legislation and the required mandated benefits applicable to all short-term, limited-duration policies.
Law/Resolve: Enacted as Public Law 2019, chapter 262
Summary of ProvisionsLD 1263: An Act Regarding Telehealth
Allows a physician assistant or an advanced practice registered nurse licensed as such in this State to perform abortions, in addition to a licensed allopathic or osteopathic physician.
Law/Resolve: Enacted as Public Law 2019, chapter 289
Summary of ProvisionsLD 1272: An Act To Increase Access to Low-cost Prescription Drugs
Public Law 2019, chapter 289 does the following.
- Provides immunity from liability to health care practitioners who voluntarily provide health care services through telehealth in the same manner as immunity is provided to health care practitioners who voluntarily provide health care services in person.
- Requires carriers that offer health plans in this State to provide coverage for health care services provided through telehealth services in the same manner as coverage is provided for services provided in person and sets forth certain standards for coverage of telehealth services.
The requirements of Public Law 2019, chapter 289 apply to health insurance policies issued or renewed on or after January 1, 2020.
- Clarifies that carriers may apply prior approval and credentialing requirements for providers for services provided through telehealth services only if the requirements are the same as are applied for services provided in person.
Law/Resolve: Enacted as Public Law 2019, chapter 472
Summary of ProvisionsLD 1274: An Act To Enact the Health Insurance Consumer Assistance Program
Establishes a wholesale importation program for prescription drugs from Canada by or on behalf of the State in order to provide cost savings to consumers. The law directs the Department of Health and Human Services to consider whether the program may be developed on a multistate basis through collaboration with other states. The law requires the Department of Health and Human Services to design the program through rulemaking by January 1, 2020. The rules are designated as major substantive and must be submitted to the Legislature for final approval. The law also specifies that the program may not be implemented until the State has received federal approval and certification. The bill directs the Department of Health and Human Services to apply for federal approval no later than May 1, 2020.
Law/Resolve: Enacted as Public Law 2019, chapter 522
Summary of ProvisionsLD 1313: An Act To Enact the Maine Death with Dignity Act
Establishes the Health Insurance Consumer Assistance Program to provide support for consumers, including prospective consumers, of health insurance and to health insurance customer assistance programs and health insurance ombudsman programs. The services the new program will provide include assisting with filing complaints and appeals regarding decisions made by a group health plan, health insurance carrier or independent review organization and obtaining health insurance premium tax credits on behalf of consumers. The Attorney General is required to contract with a nonprofit, independent health insurance consumer assistance entity that is not an insurer to operate the consumer assistance program.
Law/Resolve: Enacted as Public Law 2019, chapter 271
Summary of ProvisionsLD 1314: An Act To Extend Protections for Genetic Information
This law allows terminally ill adults to request a prescription for a lethal dose of medication, under certain circumstances. The law in part affects insurers that write life, health or accident, annuity, or medical professional liability coverage. New 22 M.R.S. § 2140(19):
- prohibits the sale, procurement, or issuance of a life, health or accident, or annuity policy from being conditioned upon or affected by a qualified patient’s making or rescinding a request for medication to self-administer to end his or her life in accordance with the Act
- prohibits the denial of benefits under a life insurance policy to a qualified patient who has self-administered life-ending medication in accordance with the Act
- requires that the rating, sale, procurement, or issuance of any medical professional liability insurance policy delivered or issued for delivery in Maine be in accordance with the provisions of Title 24-A.
Law/Resolve: Enacted as Public Law 2019, chapter 208
Summary of ProvisionsLD 1353: An Act To Establish Transparency in Primary Health Care Spending
Requires that an insurer obtain the informed written consent of an individual before requesting, requiring, purchasing or using any information from an entity providing direct-to-consumer genetic testing in connection with the issuance, withholding, extension or renewal of an insurance policy for life, credit life, disability, long-term care, accidental injury, specified disease, hospital indemnity or credit accident insurance or an annuity.
Law/Resolve: Enacted as Public Law 2019, chapter 244
Summary of ProvisionsLD 1499: An Act To Establish the Maine Prescription Drug Affordability Board
Requires the Maine Quality Forum to submit an annual report, beginning January 15, 2020, to the Department of Health and Human Services and the joint standing committee of the Legislature having jurisdiction over health coverage and health insurance matters, based on claims data reported to the Maine Health Data Organization and information on methods of reimbursement for primary care reported by insurers. The annual report is required to include the percentage of total medical expenditures paid for primary care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust, the average percentage of total medical expenditures paid for primary care across all payors and the methods used by these organizations to pay for primary care. The law also requires the Maine Quality Forum to consult with other state and national agencies and organizations on best practices in health care spending reporting.
Law/Resolve: Enacted as Public Law 2019, chapter 471
Summary of ProvisionsLD 1504: An Act To Protect Consumers from Unfair Practices Related to Pharmacy Benefits Management
Establishes the Maine Prescription Drug Affordability Board. The law provides that the board determines prescription drug spending targets for public entities, including for specific prescription drugs, based upon a 10-year rolling average of the medical care services component of the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care services index plus a reasonable percentage for inflation and minus a spending target determined by the board for pharmacy savings and in consideration of information received about the public entity’s prescription drug spending and information collected by the Maine Health Data Organization. The board makes recommendations on prescription drug spending targets, including spending targets for specific prescription drugs, with input from representatives of those public entities. The recommendations may include establishing a common prescription drug formulary among public payors, purchasing prescription drugs in bulk or through a single purchasing agreement, collaborating with other states and state prescription drug purchasing consortia to purchase prescription drugs in bulk or to jointly negotiate rebates, allowing health insurance carriers providing coverage to small businesses in the State to participate in a public payor prescription drug benefit for a fee, procuring common pharmacy benefit management services and actuarial services, negotiating specific rebates and removing drugs for which a manufacturer does not negotiate a sufficient rebate from a formulary and other methods determined by the board. The board is required to report its prescription drug spending targets and the methods recommended to meet those targets to the Legislature annually.
Law/Resolve: Enacted as Public Law 2019, chapter 469
Summary of ProvisionsLD 1615: An Act To Enact the Peer-to-peer Car Sharing Insurance Act
Replaces the current registration requirement for pharmacy benefits managers doing business in this State with a licensing requirement beginning January 1, 2020. The law imposes the following requirements on a carrier that provides prescription drug benefits.
- Makes a carrier responsible for monitoring its activities, or all activities carried out on its behalf by a pharmacy benefits manager, related to the carrier's prescription drug benefits and for ensuring that all requirements of the law are met.
- If a carrier contracts with a pharmacy benefits manager to perform any activities related to the carrier's prescription drug benefits, it makes the carrier responsible for ensuring that the pharmacy benefits manager acts as the carrier's agent and owes a fiduciary duty to the carrier.
- Prohibits a carrier from entering into a contract or agreement or allowing a pharmacy benefits manager or any person acting on the carrier's behalf to enter into a contract or agreement that prohibits a pharmacy provider from providing a consumer with the option of paying the cash price for the purchase of a prescription drug and not filing a claim with the consumer's carrier if the cash price is less than the covered person's cost-sharing amount or providing information to a state or federal agency, law enforcement agency or the Superintendent of Insurance when such information is required by law.
- Prohibits a carrier or pharmacy benefits manager from requiring a consumer to make an excessive payment at the point of sale for a covered prescription drug.
- Requires a carrier to provide a reasonably adequate retail pharmacy network and specifies that a mail order pharmacy may not be included in determining the adequacy of a retail pharmacy network.
- Replaces and updates current law related to the use of a maximum allowable cost list by a carrier or pharmacy benefits manager under contract with a carrier. It also clarifies how a carrier or pharmacy benefits manager may determine the average wholesale price of a brand-name drug or generic drug not included on the maximum allowable cost list.
- Specifies how to calculate the amount paid by a carrier or a carrier's pharmacy benefits manager to a pharmacy provider under contract with the carrier or the carrier's pharmacy benefits manager for dispensing a prescription drug.
- Requires that all compensation remitted by or on behalf of a pharmaceutical manufacturer, developer or labeler, directly or indirectly, to a carrier or to a pharmacy benefits manager related to its prescription drug benefit must be remitted directly to the covered person at the point of sale or to the carrier to offset premiums for covered persons. The law requires a carrier to file annual reports beginning March 1, 2021 demonstrating how the carrier has complied with this requirement.
- Prohibits a carrier from allowing a person to be a member of its pharmacy and therapeutics committee if the member has a conflict of interest because of a relationship with, or compensation from, a pharmaceutical manufacturer, developer, labeler, wholesaler or distributor.
- Requires a carrier to maintain certain records related to the administration and provision of prescription drug benefits under a health plan and authorizes the carrier to audit those activities. The law also authorizes the superintendent to have access to records upon request.
- If a carrier uses a pharmacy benefits manager to administer or manage prescription drug benefits provided for the benefit of covered persons, it provides that any pharmacy benefits manager compensation constitutes an administrative cost incurred by a carrier for purposes of calculating the anticipated loss ratio. "Pharmacy benefits manager compensation" is defined in the law as the difference between the value of payments made by a carrier of a health plan to its pharmacy benefits manager and the value of payments made by the pharmacy benefits manager to dispensing pharmacists for the provision of prescription drugs or pharmacy services with regard to pharmacy benefits covered by the health plan.
The provisions in Public Law 2019, chapter 469 take effect January 1, 2020.
- Clarifies that the definition of "carrier" does not include a multiple-employer welfare arrangement if the multiple-employer welfare arrangement contracts with a 3rd-party administrator to manage and administer health benefits, including benefits for prescription drugs.
Law/Resolve: Enacted as Public Law 2019, chapter 367
Summary of ProvisionsLD 1694: Resolve, To Determine Compliance with Federal and State Mental Health Parity Laws
Establishes insurance requirements for peer-to-peer car sharing programs. The law also sets forth parameters for liability when a loss or injury occurs during a car sharing period or while a motor vehicle is under the control of a peer-to-peer car sharing program.
Law/Resolve: Finally Passed as Resolve 2019, chapter 72
Summary of ProvisionsLD 1793: An Act To Update the Laws Governing Personal Vehicle Rental Coverage
Requires the Superintendent of Insurance to determine the compliance of health insurance carriers doing business in this State with federal and state mental health parity laws. The Superintendent of Insurance is required to either authorize a market conduct examination or use a survey tool to assess compliance and to report back to the Joint Standing Committee on Health Coverage, Insurance and Financial Services no later than January 30, 2020. The committee is authorized to report out legislation to the Second Regular Session of the 129th Legislature based on the results.
Law/Resolve: Enacted as Public Law 2019, chapter 376
Summary of ProvisionsLD 1829: An Act Regarding Insurance Licensees
Amends the definition of "private passenger motor vehicle" in the laws governing personal automobile insurance and rental vehicle coverage in the Maine Insurance Code. It clarifies that "private passenger motor vehicle" includes a sport utility vehicle, a pickup truck and a van, which are commonly rented vehicles and requires the Superintendent of Insurance to adopt rules, including rules to further define the term "private passenger motor vehicle."
Law/Resolve: Enacted as Public Law 2019, chapter 382
Summary of Provisions
Provides a fee of $150 for surplus lines authority. It authorizes the Superintendent of Insurance to cancel the Maine license or authority of a nonresident insurance licensee subject to the Maine Revised Statutes, Title 24-A, chapter 16. Such a cancellation applies to a nonresident licensee only in the event that the licensee's license authority in the licensee's home state is no longer active and the Maine license has been granted on a reciprocal basis. It removes language that prohibits an adjuster seeking to provide adjusting services to an insured for a fee to be paid by the insured from soliciting an adjustment services contract to any person for at least 36 hours after an accident or occurrence as a result of which the person might have a potential claim. Also authorizes the Joint Standing Committee on Health Coverage, Insurance and Financial Services to report out a bill to the Second Regular Session of the 129th Legislature relating to the law governing the activities of licensed insurance adjusters.