APPROVED CHAPTER
APRIL 2, 2024 591
BY GOVERNOR PUBLIC LAW
STATE OF MAINE
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IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-FOUR
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H.P. 1164 - L.D. 1832
An Act to Continue the Study of Community Paramedicine and to Make
Changes Related to Health Insurance Coverage and Prior Authorization
Requirements for Certain Ambulance Service Providers
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4303-C, sub-§2, ¶B, as amended by PL 2021, c. 222, §1, is
further amended to read:
B. Except as provided for ambulance services in paragraph D D-1, unless the carrier
and out-of-network provider agree otherwise, a carrier shall reimburse the out-of-
network provider or enrollee, as applicable, for health care services rendered at the
greater of:
(1) The carrier's median network rate paid for that health care service by a similar
provider in the geographic area where the service was provided; and
(2) The median network rate paid by all carriers for that health care service by a
similar provider in the geographic area where the service was provided as
determined by the all-payer claims database maintained by the Maine Health Data
Organization or, if Maine Health Data Organization claims data is insufficient or
otherwise inapplicable, another independent medical claims database specified by
the superintendent;
Sec. 2. 24-A MRSA §4303-C, sub-§2, ¶D-1 is enacted to read:
D-1. Unless the carrier and out-of-network provider agree otherwise, a carrier shall
reimburse an out-of-network provider for ambulance services that are covered
emergency services at the rate applicable to the out-of-network provider pursuant to
section 4303-F.
Sec. 3. 24-A MRSA §4303-F, sub-§1, ¶E, as enacted by PL 2023, c. 468, §2, is
amended to read:
E. A carrier may not require an a ground ambulance service provider to obtain prior
authorization before transporting an enrollee to a hospital, between hospitals or from a
hospital to a nursing home, hospice care facility or other health care facility, as defined
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 in Title 22, section 328, subsection 8. A carrier may not require an air ambulance
service provider to obtain prior authorization before transporting an enrollee to a
hospital or between hospitals for urgent care.
Sec. 4. 24-A MRSA §4303-F, sub-§3, as enacted by PL 2021, c. 241, §3, is
amended to read:
3. Exemption. This Except as provided in subsection 1, paragraph E, this section does
not apply to air ambulance services.
Sec. 5. Authority to report out legislation. Based on recommendations from
stakeholders after further study, the joint standing committee of the Legislature having
jurisdiction over health coverage, insurance and financial services matters may report out
legislation to the 132nd Legislature in 2025 related to reimbursement by health insurance
carriers for health care services provided by community paramedicine personnel as
described in the Maine Revised Statutes, Title 32, section 84, subsection 4.
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Statutes affected:
Bill Text ACTPUB , Chapter 591: 24-A.4303