An Act To Protect the Health of Infants
Maine Legislature, Session 123, LD 0658
Committee Amendment CA_A_H598 (House)
Amends: 24-A MRSA §2762, 24-A MRSA §2847-M, 24-A MRSA §4253

COMMITTEE AMENDMENT 'A-" to H.P. 507, L.D. 658, Bill, "An Act To 
Protect the Health of Infants" 
Amend the bill by striking everything after the enacting clause and before the 
summary and inserting in the following: 
'Sec. 1. 24 MRS A §2317-B, suh-§12-B is enacted to read: 
12-B. Title 24-A, sections 2762, 2847-M and 4253. 
Coverage for medically 
necessary infant formula, Title 24-A, sections 2762, 2847-M and 4253; 
Sec. 2. 24-A MRSA §2762 is enacted to read: 
§2762. Coverage for medically necessary infant formula 
1. 
Required coverage. All individual health insurance policies, contracts and 
certificates must provide coverage for amino acid-based elemental infant formula, 
regardless of the delivery method, that has been authorized by a licensed physician when 
determined to be medically necessary health care as defined in section 430 I-A, 
subsection 10-A for the treatment of food protein allergies and intolerances, disorders 
affecting the gastrointestinal tract and other medically diagnosed conditions. 
The 
policies, contracts and certificates must reimburse for amino acid-based elemental infant 
formula up to $6,000 per year. The policy may require prior authorization for coverage 
required by this section, but may not impose any other limitation, deductible, copayment 
or coinsurance. 
2. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after the effective date of this section. For purposes of this section, all contracts are 
deemed to be renewed no later than the next yearly anniversary ofthe contract date. 
Sec. 3. 24-A MRSA §2847-M is enacted to read: 
COMMITTEE AMENDMENT 
.. ,. 
~. 
COMMITTEE AMENDMENT ,A .. to H.P. 507, L.D. 658 
§2847-M. Coverage for medically necessary infant formula 
1. 
Required coverage. 
All group health insurance policies, contracts and 
certificates must provide coverage for amino acid-based elemental infant formula, 
regardless of the delivery method, that has been authorized by a licensed physician when 
determined to be medically necessary health care as defined in section 4301-A, 
subsection 10-A for the treatment of food protein allergies and intolerances, disorders 
affecting the gastrointestinal tract and other medically diagnosed conditions. 
The 
policies, contracts and certificates must reimburse for amino acid-based elemental infant 
formula up to $6,000 per year. The policy may require prior authorization for coverage 
required by this section, but may not impose any other limitation, deductible, copayment 
or coinsurance. 
2. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after the effective date of this section. For purposes of this section, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. 4. 24-A MRSA §4253 is enacted to read: 
§4253. Coverage for medically necessary infant formula 
1. Required coverage. All individual and group health maintenance organization 
policies, contracts and certificates must provide coverage for amino acid-based elemental 
infant formula, regardless of the delivery method, that has been authorized by a licensed 
physician when determined to be medically necessary health care as defined in section 
I-A, subsection 10-A for the treatment of food protein allergies and intolerances, 
disorders affecting the gastrointestinal tract and other medically diagnosed conditions. 
The policies, contracts and certificates must reimburse for amino acid-based elemental 
infant formula up to $6,000 per year. The policy may require prior authorization for 
coverage required by this section, but may not impose any other limitation, deductible, 
copayment or coinsurance. 
2. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after the effective date of this section. For purposes of this section, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. 5. Application. This Act applies to health insurance policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after January 1,2008. For purposes of this Act, all contracts are deemed to be renewed 
no later than the next yearly anniversary of the contract date. 
Sec. 6. Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Salary Plan 0305 
Initiative: Appropriates and allocates funds for the additional costs of health insurance to 
the State resulting from the requirement to provide coverage for medically necessary 
amino acid-based elemental infant formulas. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT·4" to H.P. 507, L.D. 658 
GENERAL FUND 
Personal Services 
GENERAL FUND TOTAL 
HIGHWAY FUND 
Personal Services 
HIGHWAY FUND TOTAL 
SUMMARY 
2007-08 
$0 
$0 
2007-08 
$0 
$0 
2008-09 
$36,810 
$36,810 
2008-09 
$14,220 
$14,220 
This amendment replaces the bill. The amendment requires health insurance carriers 
to provide coverage for medically necessary amino acid-based elemental infant formulas, 
regardless of the delivery method, for the treatment of food protein allergies and 
intolerances, gastrointestinal disorders and other medically diagnosed conditions in 
individual and group policies, contracts and certificates. Coverage must be provided for 
up to $6,000 per year. The amendment applies to all policies and contracts issued or 
renewed on or after January 1,2008. 
FISCAL NOTE REQUIRED 
(See attacbed) 
COMMITTEE AMENDMENT 
Approved: 06/15/07 
~ae 
LD658 
LR 2115(02) 
An Act To Protect the Health of Infants 
Fiscal Note for Bill as Amended by Committee Amendment '~ 
Committee: Insurance and Financial Services 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
2007-08 
$0 
$0 
$0 
$0 
2008-09 
$36,810 
$14,220 
$36,810 
$14,220 
Projections 
2009-10 
$38,651 
$14,931 
$38,651 
$14,931 
Projections 
2010-11 
$40,583 
$15,67 
$40,583 
$15,678 
Adding coverage for medically necessary amino acid-based elemental infant formulas will increase premium costs 
effective with the contract year beginning July 1, 2008. The additional employer costs across all funds to the state 
employee health insurance program is estimated to be approximately $90,000 for fiscal year 2008-09. 
A General Fund appropriation of$36,810 and a Highway Fund allocation of$14,220 are included for the salary plan 
reserve accounts to fund increases for General Fund and Highway Fund employees. The costs for employees paid by 
other funds, including a small amount for the Fund for a Healthy Maine, may require increased allotments as 
recommended by the State Budget Officer and approved by the Governor. 
Any additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulation in 
implementing this legislation can be absorbed by the bureau within existing budget resources. This fiscal note does not 
reflect the additional costs to the private health insurance market. 
LR2115(02) - Fiscal Note - Page 1 of 1