An Act to Promote Fairness and Opportunity for Working Amputees
Maine Legislature, Session 121, LD 0125
Committee: Insurance and Financial Services
Sponsors: MAYO, O'NEIL, BROMLEY, DAGGETT, GAGNON, BULL, DUDLEY, FLETCHER, PERRY, SNOWE-MELLO
Amends: 24-A MRSA §4315

Legislative Document 
No. 125 
S.P.48 
In Senate, January 21,2003 
An Act to Promote Fairness and Opportunity for Working 
Amputees 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Senator MAYO of Sagadahoc. 
Cosponsored by Representative O'NEIL of Saco and 
JOY J. O'BRIEN 
Secretary of the Senate 
Senators: BROMLEY of Cumberland, President DAGGETT of Kennebec, GAGNON of 
Kennebec, Representatives: BULL of Freeport, DUDLEY of Portland, FLETCHER of 
Winslow, PERRY of Calais, SNOWE-MELLO of Poland. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §4315 is enacted to read: 
§43l5. 
Coverage of prosthetic devices 
1. 
Definition. 
As 
used 
in 
this 
section, 
"prosthetic 
device" means an artificial device to replace , in whole or in 
part, an arm or a leg. 
2. 
Required coverage. 
A carrier shall provide coverage for 
prosthetic devices in all health plans that, at a minimum, equals 
the coverage and payment for prosthetic devices provided under 
federal laws and regulations for the aged and disabled pursuant 
to 42 United States Code, Sections 1395k, 13951 and 1395m and 42 
Code of Federal Regulations, Sections 414.202, 414.210, 414.228 
and 410.100. 
Covered benefits must be provided for a prosthetic 
device determined by the enrollee's provider to be the most 
appropriate model that adequately meets the medical needs of the 
enrollee. 
3. 
Prior 
authorization. 
A carrier 
may 
require 
prior 
authorization for prosthetic devices in the same manner as prior 
authorization is required for any other covered benefit. 
4. 
Repair or replacement. 
Coverage under this section must 
also be provided for repair or replacement of a prosthetic device 
if 
repair 
or 
replacement 
is 
determined 
appropriate 
by 
the 
enrollee's provider. 
5. 
Coverage under managed care plan. 
If coverage under 
this section is provided through a managed care plan, a carrier 
may require that prosthetic services be rendered by a provider 
who contracts with the carrier and that a prosthetic device be 
provided by a vendor designated by the carrier. 
Sec. 2. Application. 
The requirements of this Act apply to 
all policies, 
contracts and certificates executed, 
delivered, 
issued for delivery, continued or renewed in this State on or 
after January 1, 2004. 
For purposes of this Act, all contracts 
are 
deemed 
to 
be 
renewed 
no 
later 
than 
the 
next 
yearly 
anniversary of the contract date. 
SUMMARY 
This 
bill 
requires 
carriers 
to 
provide 
coverage 
for 
prosthetic devices in all health plans, except those providing 
supplemental coverage for a specific disease or other limited 
benefits. Benefits for coverage of prosthetic devices must be 
equal to those benefits provided under federal 
Currently, 
Medicare provides 
coverage for 
80% 
charge or the amount recognized as the purchase 
device, whichever is less. 
Medicare 
law. 
of the actual 
price for the 
The requirements apply to all health plan policies issued or 
renewed on or after January 1, 2004.