Primary Focus: Medical Management Limitation Title/Description: An Act Regarding the Process for Obtaining Prior Authorization for Health Insurance Purposes Citation:24-A MRSA §4304 Summary: This law prohibits prior authorization for at least one drug for each therapeutic class of medication used in MAT. The law makes the exception that a carrier may not impose any prior authorization requirements on a pregnant woman for MAT benefits for opioid use disorder. Additionally, the law revises timeframe for health plans to respond to prior authorization requests. Effective Date: Prescription provisions must be enacted by January 1, 2020, and service provisions must be enacted by July 1, 2020 Notes: Enacted through SP218/LD705
Primary Focus: Access to Services Title/Description: Equitable health care for alcoholism and drug dependency treatment Citation: 24-A M.R.S. § 2842 Summary: This statute was amended to exclude employee group insurance policies issued to employers with 20 or fewer employees insured under the group policy or to group policies designed primarily to supplement to the Civilian Health and Medical Program of the Uniformed Services. Additionally, it provided that alcoholism and drug treatment patient records are confidential. Effective Date: Amended 2015 and 2011, respectively. Notes: N/A
Status: Became law 5/2014 Summary: This bill changed the section of the state insurance law about autism coverage so that the age limit for coverage was raised to 10 years of age. Previously it had been 5 years of age.
Primary Focus: Access to Services Title/Description: Equitable health care for substance use disorder treatment Citation: 24 M.R.S. § 2329 Summary: This statute was amended to provide that alcoholism and drug treatment patient records are confidential. Effective Date: 2011 Notes: N/A
Status: Signed into law 4/2010 Summary: This bill changed the state insurance law by adding the sections about autism coverage. These sections have been changed very slightly since this bill was signed into law (the coverage age limit is now 10 years old, not 5 years old). These sections are summarized at the bottom of this page under “Maine Parity Law.”
Maine Parity Law
There are several sections of the state insurance law about parity for behavioral health conditions. There are also several identical sections about coverage for autism coverage. For the sake of clarity, these sections will be summarized as follows:
Behavioral Health coverage requirements for large employer fully-insured plans and small employer fully-insured plans with 21 or more employees
Mental health coverage requirements for individual plans and small employer fully-insured plans with 20 or fewer employees
Autism coverage requirements for all affected plans
Behavioral Health Coverage for Certain Employer Plans
Autism spectrum disorders are defined as “any of the pervasive developmental disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, published by the American Psychiatric Association, including autistic disorder, Asperger’s disorder and pervasive developmental disorder not otherwise specified.”
Treatment of autism is defined as “Habilitative or rehabilitative services, including applied behavior analysis or other professional or counseling services necessary to develop, maintain and restore the functioning of an individual to the extent possible.”
Content Disclaimer: Parity Track is a collaborative forum that works to aggregate and elevate the parity implementation work taking place across the country. The content of this website is always evolving. If you are aware of other parity-related work that is not represented on this website, please contact us so that we can continue to improve this website.