APPROVED CHAPTER
JUNE 23, 2023 275
BY GOVERNOR PUBLIC LAW
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-THREE
_____
S.P. 548 - L.D. 1383
An Act to Regulate Insurance Carrier Prior Authorization Requirements for
Rehabilitative and Habilitative Services
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4304, sub-§1, as amended by PL 2007, c. 199, Pt. B, §13, is
further amended to read:
1. Requirements for medical review or utilization review practices. A carrier must
shall appoint a medical director who is responsible for reviewing and approving the carrier's
policies governing the clinical aspects of coverage determinations by any health plan that
it offers or renews. A carrier's medical review or utilization review practices must be
governed by the standard of medically necessary health care as defined in this chapter. A
carrier shall provide clear written policies and procedures to providers and enrollees on
how to obtain a prior authorization.
Sec. 2. 24-A MRSA §4304-A is enacted to read:
§4304-A. Prior authorization for rehabilitative or habilitative services
1. Prior authorization for new episode of care prohibited for 12 visits. A carrier
may not require prior authorization for rehabilitative or habilitative services, including, but
not limited to, physical therapy services, occupational therapy services or chiropractic
services, for the first 12 visits of each new episode of care. For purposes of this subsection,
"new episode of care" means treatment for a new condition or treatment for a recurring
condition for which an enrollee has not been treated within the previous 90 days.
2. Intent. This section does not limit the right of a carrier to deny a claim when an
appropriate prospective or retrospective review concludes that the health care services or
treatment rendered were not medically necessary.
Page 1 - 131LR0694(04)


Statutes affected:
Bill Text LD 1383, SP 548: 24-A.4304
Bill Text ACTPUB , Chapter 275: 24-A.4304