Bill Summary – FastDemocracy

APPROVED                 CHAPTER
                                                                 APRIL 14, 2022                 603
                                                                 BY GOVERNOR              PUBLIC LAW
                                  STATE OF MAINE
                                          _____
                          IN THE YEAR OF OUR LORD
                        TWO THOUSAND TWENTY-TWO
                                          _____
                                  H.P. 874 - L.D. 1196
   An Act Regarding Reporting on Spending for Behavioral Health Care
Services and To Clarify Requirements for Credentialing by Health Insurance
                                Carriers
Be it enacted by the People of the State of Maine as follows:
                                         PART A
    Sec. A-1. 24-A MRSA §6903, sub-§1-A is enacted to read:
   1-A. Behavioral health care. "Behavioral health care" means services to address
mental health and substance use conditions.
    Sec. A-2. 24-A MRSA §6951, sub-§13 is enacted to read:
    13. Behavioral health care reporting. Beginning January 15, 2023 and annually
thereafter, the forum shall submit 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 a report on behavioral health care spending using claims data from
the Maine Health Data Organization and information on the methods used to reimburse
behavioral health care providers requested annually from payors. As used in this
subsection, "payor" has the same meaning as in Title 22, section 8702, subsection 8. The
report must include:
    A. Of their respective total medical expenditures, the percentage paid for behavioral
    health care by commercial insurers, the MaineCare program, Medicare, the
    organization that administers health insurance for state employees and the Maine
    Education Association benefits trust and the average percentage of total medical
    expenditures paid for behavioral health care across all payors;
    B. The total behavioral health care-related nonclaims-based payments and associated
    member months;
    C. The total payments associated with substance use disorder services that are redacted
    from the payor’s claims data submissions to the Maine Health Data Organization as
    required under 42 Code of Federal Regulations, Part 2, the methods used to redact the
    substance use disorder claims, the specific code lists that are used for procedure codes,
                                   Page 1 - 130LR0740(03)
    revenue codes and diagnosis codes, provider types and any other detail on the claim
    that is required to select the substance use disorder redacted claim; and
    D. The methods used by commercial insurers, the MaineCare program, Medicare, the
    organization that administers health insurance for state employees and the Maine
    Education Association benefits trust to pay for behavioral health care.
Within 60 days of a request from the Maine Health Data Organization, a payor shall provide
the supplemental datasets specific to payments for behavioral health care services
necessary to provide the information required in paragraphs B and C. In its request to a
payor, the organization shall specify the time period for which the data is requested and
define the datasets requested to ensure uniformity in the data submitted by payors.
   Sec. A-3. Maine Quality Forum to conduct health spending reporting
study. The Maine Quality Forum, established in the Maine Revised Statutes, Title 24-A,
section 6951, shall consult with other state and national agencies and organizations to
determine the best practices for reporting spending on behavioral health care by insurers.
For purposes of this section, "behavioral health care" means services to address mental
health and substance use conditions.
                                         PART B
    Sec. B-1. 24-A MRSA §4303, sub-§2, ¶D, as amended by PL 2015, c. 84, §1, is
further amended to read:
    D. A carrier shall make credentialing decisions, including those granting or denying
    credentials, within 60 days of receipt of a completed credentialing application from a
    provider. The time period for granting or denying credentials may be extended upon
    written notification from the carrier within 60 days following submission of a
    completed application stating that information contained in the application requires
    additional time for verification. All credentialing decisions must be made within 180
    days of receipt of a completed application. For the purposes of this paragraph, an
    application is completed if the application includes all of the information required by
    the uniform credentialing application used by carriers and providers in this State, such
    attachments to that application as required by the carrier at the time of application and
    all corrections required by the carrier. A Within 30 days of initial receipt of a
    credentialing application, a carrier shall review the entire application before returning
    and, if it is incomplete, shall return it to the provider for corrections with a
    comprehensive list of all corrections needed at the time the application is first returned
    to the provider. A carrier may not require that a provider have a home address within
    the State before accepting an application. A carrier that is unable to make a
    credentialing decision on a completed credentialing application within the 60-day
    period as required in this paragraph shall notify the bureau in writing prior to the
    expiration of the 60-day period on that application and request authorization for an
    extension on that application. A carrier that requests an extension shall also submit to
    the bureau an explanation of the reasons why the credentialing decision on an
    application is taking longer than is permitted or, if the problem is not specific to a
    particular application, a written remediation plan to bring the carrier’s credentialing
    practices in line with the 60-day limit in this paragraph.
                                    Page 2 - 130LR0740(03)
    Sec. B-2. Bureau of Insurance review. The Department of Professional and
Financial Regulation, Bureau of Insurance shall review the requirements in Bureau of
Insurance rule Chapter 850, Health Plan Accountability, related to the verification of
information on credentialing applications from health care practitioners and determine
whether amendments must be made to the rule’s requirements in order to improve the
ability of carriers to make a credentialing decision within the 60-day period in accordance
with the Maine Revised Statutes, Title 24-A, section 4303, subsection 2, paragraph D
without an impact on quality standards or accreditation standards. Notwithstanding Title
24-A, section 4309, any amendments to Bureau of Insurance rule Chapter 850 adopted
following the review required by this section are routine technical rules as defined in Title
5, chapter 375, subchapter 2-A.
    Sec. B-3. Appropriations and allocations. The following appropriations and
allocations are made.
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF
Insurance - Bureau of 0092
Initiative: Provides funding for one Senior Insurance Examiner position and related All
Other costs to examine insurer requests related to accreditation of health care providers.
OTHER SPECIAL REVENUE FUNDS                                      2021-22            2022-23
 POSITIONS - LEGISLATIVE COUNT                                      0.000             1.000
 Personal Services                                                     $0          $121,132
 All Other                                                             $0           $10,803
                                                              __________        __________
OTHER SPECIAL REVENUE FUNDS TOTAL                                      $0          $131,935
                                   Page 3 - 130LR0740(03)
Statutes affected: 
Bill Text LD 1196, HP 874: 24-A.2303
Bill Text ACTPUB , Chapter 603: 24-A.4303