LAW WITHOUT
GOVERNOR'S CHAPTER
SIGNATURE
28
MARCH 25, 2021 PUBLIC LAW
STATE OF MAINE
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IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-ONE
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S.P. 29 - L.D. 1
An Act To Establish the COVID-19 Patient Bill of Rights and To Amend the
Governor's Emergency Powers
Emergency preamble. Whereas, acts and resolves of the Legislature do not
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, the spread of the novel coronavirus disease referred to as COVID-19 has
created a public health emergency; and
Whereas, in response to COVID-19, the World Health Organization has declared a
pandemic, the President of the United States has declared a national emergency and the
Governor of Maine has declared a civil state of emergency; and
Whereas, in response to COVID-19, the Governor of Maine has also proclaimed an
insurance emergency pursuant to the Maine Revised Statutes, Title 24-A, section 471 and,
pursuant to that proclamation, the Superintendent of Insurance has issued orders relating to
health insurance coverage for COVID-19 screening, testing and immunization during the
civil state of emergency; and
Whereas, it is important to maintain these important consumer protections related to
health insurance coverage once the civil state of emergency expires; and
Whereas, the purpose of this legislation is to ensure that those consumer protections
are codified in state law; and
Whereas, in the judgment of the Legislature, these facts create an emergency within
the meaning of the Constitution of Maine and require the following legislation as
immediately necessary for the preservation of the public peace, health and safety; now,
therefore,
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1. 22 MRSA §1718-D, sub-§2, as amended by PL 2019, c. 668, §1, is
further amended to read:
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 2. Prohibition on balance billing. An out-of-network provider reimbursed for a
surprise bill or a bill for covered emergency services under Title 24‑A, section 4303‑C or,
if there is a dispute, under Title 24‑A, section 4303‑E or a bill for COVID-19 screening and
testing under Title 24-A, section 4320-P may not bill an enrollee for health care services
beyond the applicable coinsurance, copayment, deductible or other out-of-pocket cost
expense that would be imposed for the health care services if the services were rendered
by a network provider under the enrollee's health plan. For an enrollee subject to
coinsurance, the out-of-network provider shall calculate the coinsurance amount based on
the median network rate for that health care service under the enrollee's health plan. An
out-of-network provider is also subject to the following with respect to any overpayment
made by an enrollee.
A. If an out-of-network provider provides health care services covered under an
enrollee's health plan and the out-of-network provider receives payment from the
enrollee for health care services for which the enrollee is not responsible pursuant to
this subsection, the out-of-network provider shall reimburse the enrollee within 30
calendar days after the earlier of the date that the provider received notice of the
overpayment and the date the provider became aware of the overpayment.
B. An out-of-network provider that fails to reimburse an enrollee for an overpayment
as required by paragraph A shall pay interest on the overpayment at the rate of 10%
per annum beginning on the earlier of the date the provider received notice of the
overpayment and the date the provider became aware of the overpayment. An enrollee
is not required to request the accrued interest from the out-of-network provider in order
to receive interest with the reimbursement amount.
Sec. A-2. 22 MRSA §1718-G is enacted to read:
§1718-G. Requirements for notice to patients of costs for COVID-19 screening and
testing and prohibited charges for COVID-19 vaccination for uninsured
patients
1. COVID-19 defined. For the purposes of this section, “COVID-19” has the same
meaning as in Title 24-A, section 4320-P, subsection 1, paragraph A.
2. Notice of costs for COVID-19 screening and testing. A provider, as defined in
Title 24-A, section 4301-A, subsection 16, shall, at the time a patient schedules or registers
for screening or testing services and before providing screening or testing services for
COVID-19:
A. Provide notice of any payment or upfront charge and the amount of that payment or
charge that will be due from the patient for the services, including payments or charges
for which the provider will submit a claim on the patient’s behalf or for which the
patient will need to submit a claim for reimbursement to the patient's health insurance
carrier or to the department;
B. To the extent applicable, provide the form for requesting coverage from the
department through emergency MaineCare coverage; and
C. To the extent applicable, inform any patient who will be required to make a payment
or upfront charge that there are locations where COVID-19 screening and testing
services are provided without such payments and that those locations are identified on
the State’s publicly accessible website.
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 3. Charges to uninsured patients for COVID-19 vaccination prohibited. A
provider, as defined in Title 24-A, section 4301-A, subsection 16, may not charge an
uninsured patient any amount for administering a COVID-19 vaccine or any associated
costs of administration.
4. Rules. The department may adopt rules to implement and administer this section to
align with any applicable federal regulations. Rules adopted pursuant to this subsection are
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. A-3. 24-A MRSA §4320-P is enacted to read:
§4320-P. Coverage for health care services for COVID-19
Notwithstanding any requirements of this Title to the contrary, a carrier offering a
health plan in this State shall provide, at a minimum, coverage as required by this section
for screening, testing and immunization for COVID-19.
1. Definitions. For the purposes of this section, unless the context otherwise indicates,
the following terms have the following meanings.
A. "COVID-19" means the coronavirus disease 2019 resulting from SARS-CoV-2,
severe acute respiratory syndrome coronavirus 2, and any virus mutating from that
virus.
B. "Surveillance testing program" means a structured program of asymptomatic testing
at a community or population level to understand the incidence or prevalence of
COVID-19 in a group. "Surveillance testing program" does not include a program of
testing that occurs less often than once per month per individual.
2. Testing. A carrier shall provide coverage for screening and testing for COVID-19
as follows.
A. A carrier shall provide coverage for screening and testing for COVID-19, except
when such screening and testing is part of a surveillance testing program.
B. A carrier may not impose any deductible, copayment, coinsurance or other cost-
sharing requirement for the costs of COVID-19 screening and testing, including all
associated costs of administration.
C. A carrier may not make coverage without cost sharing as required by paragraph B
dependent on any prior authorization requirement.
D. A carrier may not make coverage without cost sharing as required by paragraph B
dependent on the use of a provider in a carrier's network unless an enrollee is offered
screening and testing by a network provider without additional delay and the enrollee
chooses instead to obtain screening from an out-of-network provider or to be tested by
an out-of-network laboratory.
E. For the purposes of this subsection, with respect to COVID-19 screening and testing
rendered by an out-of-network provider, a carrier shall reimburse the out-of-network
provider in accordance with section 4303-C, subsection 2, paragraph B.
3. Immunization; COVID-19 vaccines. A carrier shall provide coverage for COVID-
19 vaccines as follows.
A. A carrier shall provide coverage for any COVID-19 vaccine licensed or authorized
under an emergency use authorization by the United States Food and Drug
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 Administration that is recommended by the United States Centers for Disease Control
and Prevention Advisory Committee on Immunization Practices, or successor
organization, for administration to an enrollee.
B. A carrier may not impose any deductible, copayment, coinsurance or other cost-
sharing requirement for the cost of COVID-19 vaccines, including all associated costs
of administration.
C. A carrier may not make coverage without cost sharing as required by paragraph B
dependent on any prior authorization requirement.
D. A carrier may not make coverage without cost sharing as required by paragraph B
dependent on the use of a provider in a carrier's network unless an enrollee is offered
immunization by a network provider without additional delay and the enrollee chooses
instead to obtain immunization from an out-of-network provider.
4. Rules. The superintendent may adopt rules to implement and administer this section
to align with any applicable federal requirements. Rules adopted pursuant to this subsection
are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. A-4. Exemption from mandate review. Notwithstanding the Maine
Revised Statutes, Title 24-A, section 2752, this Part is enacted without review and
evaluation by the Department of Professional and Financial Regulation, Bureau of
Insurance.
PART B
Sec. B-1. 24-A MRSA §4311, sub-§2-A is enacted to read:
2-A. Coverage of prescription during emergency declared by the Governor.
Except as provided in this subsection, a carrier shall provide coverage for the furnishing or
dispensing of a prescription drug in accordance with a valid prescription issued by a
provider in a quantity sufficient for an extended period of time, not to exceed a 180-day
supply, during a statewide state of emergency declared by the Governor in accordance with
Title 37-B, section 742. This subsection does not apply to coverage of prescribed
contraceptive supplies furnished and dispensed pursuant to section 2756, 2847-G or 4247
or coverage of opioids prescribed in accordance with limits set forth in Title 32.
Sec. B-2. 32 MRSA §13831, sub-§2-A is enacted to read:
2-A. Administration of COVID-19 vaccines. A pharmacist licensed in this State
who meets the qualifications and requirements of section 13832 and rules adopted by the
board may administer and order COVID-19 vaccines licensed or authorized under an
emergency use authorization by the United States Food and Drug Administration that are
recommended by the United States Centers for Disease Control and Prevention Advisory
Committee on Immunization Practices, or successor organization, to a person 3 years of
age or older. For the purposes of this subsection, "COVID-19" has the same meaning as in
Title 24-A, section 4320-P, subsection 1, paragraph A.
Sec. B-3. Exemption from mandate review. Notwithstanding the Maine Revised
Statutes, Title 24-A, section 2752, section 1 of this Part is enacted without review and
evaluation by the Department of Professional and Financial Regulation, Bureau of
Insurance.
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 PART C
Sec. C-1. 37-B MRSA §742, sub-§1, ¶E is enacted to read:
E. In dealing with a declared state of emergency under this subsection, the Governor
shall ensure that:
(1) Medical privacy and confidentiality requirements, including but not limited to
requirements under the federal Health Insurance Portability and Accountability Act
of 1996, are followed; and
(2) Health care services and surgeries are not considered to be nonessential
services.
PART D
Sec. D-1. Permitted delegation of COVID-19 vaccine administration at
point-of-dispensing vaccine sites for immunizations against COVID-19. This
section governs the permitted delegation of COVID-19 vaccine administration at point-of-
dispensing vaccine sites for immunizations against COVID-19. For the purposes of this
section, "COVID-19" means the coronavirus disease 2019 resulting from SARS-CoV-2,
severe acute respiratory syndrome coronavirus 2, and any virus mutating from that virus.
1. Applicability. This section applies only to point-of-dispensing vaccine sites that
have a written memorandum of understanding with the Department of Health and Human
Services, Maine Center for Disease Control and Prevention to administer vaccines against
COVID-19. This section is effective only during the state of emergency declared by the
Governor due to COVID-19 as of March 15, 2020 and any renewals of that declaration in
accordance with the Maine Revised Statutes, Title 37-B, section 742 and Title 22, section
801, subsection 4-A and section 802, subsection 2-A.
2. Permitted delegation of COVID-19 vaccine administration. Any on-site
clinician in charge of a point-of-dispensing vaccine site with a memorandum of
understanding that complies with the requirements of subsection 4 may delegate the
administration of COVID-19 vaccines within the State to employees, staff, agents or
volunteers as long as the on-site clinician in charge is currently licensed by the State as a
physician, advanced practice registered nurse or physician assistant and any employee, staff
member, agent or volunteer to whom such authority is delegated under this section is
subject to the supervision and control of the point-of-dispensing vaccine site and any on-
site clinician in charge and has completed the training and observation required in
subsection 3. Any individual to whom vaccine administration is delegated under this
section is authorized to administer any COVID-19 vaccine identified as a "covered
countermeasure" in the 4th amendment to the declaration by the Secretary of the United
States Department of Health and Human Services under the federal Public Readiness and
Emergency Preparedness Act, referred to in this section as "the PREP Act," or in any
subsequent declaration under that Act, and that meets the 42 United States Code, Section
247d-6d(i)(1) definition of ''covered countermeasure."
3. Training and observation. Prior to undertaking any vaccine administration,
anyone to whom vaccine administration is delegated under subsection 2 must complete the
United States Department of Health and Human Services, Centers for Disease Control and
Prevention COVID-19 vaccine training modules; any applicable training required by the
PREP Act or any declaration issued pursuant to that Act for medical countermeasures
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against COVID-19 or guidance from an authority having jurisdiction under such
declaration; and any applicable observation period by a currently practicing health care
professional adequately experienced in vaccination who confirms competency in
preparation and administration of the particular COVID-19 vaccine or vaccines to be
administered by the individual, if required by the PREP Act or in any declaration or
guidance under that Act. The individual must provide documentation of any training and
observation required by this section to the point-of-dispensing vaccine site and the on-site
clinician in charge prior to any administration of a COVID-19 vaccine as authorized by this
section.
4. Requirements for the memorandum of understanding and other record
keeping. Any on-site clinician in charge of a point-of-dispensing vaccine site may make a
delegation under subsection 2 only if the point-of-dispensing vaccine site's memorandum
of understanding or addendum to that memorandum of understanding identifies the
clinician in charge by name. The point-of-dispensing vaccine site and the Department of
Health and Human Services, Maine Center for Disease Control and Prevention shall each
retain a copy of the memorandum of understanding for a period of 3 years. The point-of-
dispensing vaccine site and on-site clinician in charge are each responsible for retaining for
a period of 3 years a record of the name of each individual to whom vaccine administration
is delegated under subsection 2 and evidence of each individual's completion of the
required training and observation.
5. Delegation authority under other state law. The authority to delegate the
administration of COVID-19 vaccines granted in this section is in addition to any
delegation authority that may otherwise exist under state law. Clinicians in charge who
exercise delegation authority pursuant to other state law are not required to comply with
the requirements of this section.
Emergency clause. In view of the emergency cited in the preamble, this legislation
takes effect when approved.
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Statutes affected:
Bill Text LD 1, SP 29: 24.2904, 24-A.4316
Bill Text ACTPUB , Chapter 28: 22.1718