An Act To 0 Protect the Health of Infants
Maine Legislature, Session 123, LD 0658
Committee Amendment CA_B_H891 (House)
Amends: 24 MRSA §2317-B, 24-A MRSA §2763, 24-A MRSA §2847-N, 24-A MRSA §4254

COMMITTEE AMENDMENT 'B" to H.P. 507, L.D. 658, Bill, "An Act To 
0 
Protect the Health of Infants" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24 MRSA §2317-B, sub-§12-C is enacted to read: 
12-C. 
Title 24-A, sections 2763, 2847-N and 4254. 
Coverage for medically 
necessary infant formula, Title 24-A, sections 2763, 2847-N and 4254; 
Sec. 2. 24-A MRSA §2763 is enacted to read: 
§2763. Coverage for medically necessary infant formula 
All individual health insurance policies, contracts and certificates must provide 
coverage for amino acid-based elemental infant fonnula for children 2 years of age and 
under in accordance with this section. 
1. Determination of medical necessity. Coverage for amino acid-based elemental 
infant formula must be provided when a licensed physician has submitted documentation 
that the amino acid-based elemental infant formula is medically necessary health care as 
defined in section 4301-A, subsection 10-A, that the amino acid-based elemental infant 
formula is the predominant source of nutritional intake at a rate of 50% or greater and that 
other commercial infant formulas, including cow milk-based and soy milk-based 
formulas have been tried and have failed or are contraindicated. A licensed physician may 
be required to confirm and document ongoing medical necessity at least annually. 
2. Method of delivery. Coverage for amino acid-based elemental infant formula 
must be provided without regard to the method of delivery of the formula. 
3. Required diagnosis. Coverage for amino acid-based elemental infant formula 
must be provided when a licensed physician has diagnosed and through medical 
evaluation has documented one of the following conditions: 
COMMITTEE AMENDMENT 
, 
~, r, 
COMMITTEE AMENDMENT ':b" to H.P. 507, L.D. 658 
A. Symptomatic allergic colitis or proctitis; 
B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis; 
C. A history of anaphylaxis; 
D. 
Gastroesophageal reflux disease that is nonresponsive to standard medical 
therapies; 
E. 
Severe vomltmg or diarrhea resulting in clinically significant dehydration 
requiring treatment by a medical provider; 
F. Cystic fibrosis; or 
G. Malabsorption of cow milk-based or soy milk-based infant formula. 
4. 
Health savings accounts. 
Coverage for amino acid-based elemental infant 
formula under a health insurance policy, contract or certificate issued in connection with 
a health savings account as authorized under Title XII of the federal Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the 
same deductible and out-of-pocket limits that apply to overall benefits under the policy, 
contract or certificate. 
Sec. 3. 24-A MRSA §2847-N is enacted to read: 
§2847-N. Coverage for medically necessary infant formula 
All group health insurance policies, contracts and certificates must provide coverage 
for amino acid-based elemental infant formula for children 2 years of age and under in 
accordance with this section. 
1. Determination of medical necessity. Coverage for amino acid-based elemental 
infant formula must be provided when a licensed physician has submitted documentation 
that the amino acid-based elemental infant formula is medically necessary health care as 
defined in section 4301-A, subsection 10-A, that the amino acid-based elemental infant 
formula is the predominant source of nutritional intake at a rate of 50% or greater and that 
other commercial infant formulas, including cow milk-based and soy milk-based 
formulas have been tried and have failed or are contraindicated. A licensed physician may 
be required to confirm and document ongoing medical necessity at least annually. 
2. Method of delivery. Coverage for amino acid-based elemental infant formula 
must be provided without regard to the method of delivery of the formula. 
3. Required diagnosis. Coverage for amino acid-based elemental infant formula 
must be provided when a licensed physician has diagnosed and through medical 
evaluation has documented one of the following conditions: 
A. Symptomatic allergic colitis or proctitis; 
B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis; 
C. A history of anaphylaxis; 
D. 
Gastroesophageal reflux disease that is nonresponsIve to standard medical 
therapies; 
COMMITTEE AMENDMENT 
,;... I.~ 
COMMITTEE AMENDMENT .lj .. to H.P. 507, L.D. 658 
E. 
Severe vomiting or diarrhea resulting in clinically significant dehydration 
requiring treatment by a medical provider; 
F. Cystic fibrosis; or 
G. Malabsorption of cow milk-based or soy milk-based infant formula. 
4. 
Health savings accounts. 
Coverage for amino-acid based elemental infant 
formula under a health insurance policy, contract or certificate issued in connection with 
a health savings account as authorized under Title XII of the federal Medicare 
Prescription Drug, Improvement. and Modernization Act of 2003 may be subject to the 
same deductible and out-of-pocket limits that apply to overall benefits under the policy, 
contract or certificate. 
Sec. 4. 24-A MRSA §4254 is enacted to read: 
§4254. Coverage for medically necessary infant formula 
All individual and group -health maintenance organization policies, contracts and 
certificates must provide coverage for amino acid-based elemental infant formula for 
children 2 years of age and under in accordance with this section. 
1. Determination of medical necessity. Coverage for amino acid-based elemental 
infant formula must be provided when a licensed physician has submitted documentation 
that the amino acid-based elemental infant formula is medically necessary health care as 
defined in section 430 I-A, subsection 10-A, that the amino acid-based elemental infant 
formula is the predominant source of nutritional intake at a rate of 50% or greater and that 
other commercial infant formulas, including cow milk-based and soy milk-based 
formulas have been tried and have failed or are contraindicated. A licensed physician may 
be required to confirm and document ongoing medical necessity at least annually. 
2. Method of delivery. Coverage for amino acid-based elemental infant formula 
must be provided without regard to the method of delivery of the formula. 
3. Required diagnosis. Coverage for amino acid-based elemental infant formula 
must be provided when a licensed physician has diagnosed and through medical 
evaluation has documented one of the following conditions: 
A. Symptomatic allergic colitis or proctitis; 
B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis; 
C. A history of anaphylaxis; 
D. 
Gastroesophageal reflux disease that is nonresponsive to standard medical 
therapies; 
E. 
Severe vomiting or diarrhea resulting in clinically significant dehydration 
requiring treatment by a medical provider; 
F. Cystic fibrosis; or 
G. Malabsorption of cow milk-based or soy milk-based infant formula. 
4. 
Health savings accounts. 
Coverage for amino acid-based elemental infant 
formula under a health insurance policy, contract or certificate issued in connection with 
COMMITTEE AMENDMENT 
" 
~. 
COMMITTEE AMENDMENT:B" to H.P. 507, L.D. 658 
a health savings account as authorized under Title XII of the federal Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the 
same deductible and out-of-pocket limits that apply to overall benefits under the policy, 
contract or certificate. 
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 1,2009. 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 amendment replaces the bill and is the majority report of the committee. The 
amendment requires health insurance carriers to provide coverage for amino acid-based 
elemental infant formulas for children 2 year of age and under, regardless of the delivery 
method, for the treatment of certain specified medical conditions when the infant formula 
is determined to be medically necessary. The amendment applies to all policies, contracts 
and certificates issued or renewed on or after January 1,2009. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Revised: 03/25/08 frac 
LD658 
LR 2115(04) 
An Act To Protect the Health of Infants 
Fiscal Note for Bill as Amended by Committee Amendment ,Jj" 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Multiple Funds 
Any additional costs to the State Employee Health Plan are expected to be minor and can be absorbed within existing 
budgeted resources. 
Any additional costs to the Bureau ofInsurance in the Department of Professional and Financial Regulation in 
implementing this legislation can be absorbed by the bureau within existing budget resources. 
LR2115(04) - Fiscal Note - Page I of I