An Act To Require Private Insurance Coverage for Celiain Services for Children with Disabilities
Maine Legislature, Session 124, LD 0425
Committee Amendment CA_A_H663 (House)
Amends: 24-A MRSA §2766, 24-A MRSA §2847-R, 24-A MRSA §4258

COMMITTEE AMENDMENT" A " 
to H.P. 313, L.D. 425, Bill, "An Act To 
Require Private Insurance Coverage for Celiain Services for Children with Disabilities" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24 MRS A §2317-B, sub-§12-F is enacted to read: 
12-F. Title 24-A, section 2766, 2847-Rand 4258. 
Coverage for children's early 
intervention services, Title 24-A, sections 2766, 2847-R and 4258; 
Sec. 2. 24-A MRSA §2766 is enacted to read: 
§2766. Coverage for children's early intervention services 
1. Definition. For purposes of this section, "children's early intervention services" 
means services provided by licensed occupational therapists, physical therapists, speech-
language pathologists or clinical social workers working with children from bilih to 36 
months of age with an identified developmental disability or delay as described in the 
federal Individuals with Disabilities Education Act, Part' C, 20 United States Code, 
Section 1411, et seq. 
2. 
Required coverage. All individual health insurance policies, contracts and 
celiificates must provide coverage for children's early intervention services in accordance, 
with this subsection. 
A. A referral from the child's primary care provider is required. 
B. The policy, contract or celiificate may limit coverage to $3,200 per year for each 
child not to exceed $9,600 by the child's 3rd biIihday. 
C. The policy, contract or celiificate may contain provisions for maximum benefits 
and coinsurance and reasonable limitations, deductibles and exclusions to the extent 
that these provisions are not inconsistent with the requirements of this section. 
Sec. 3. 24-A MRSA §2847-R is enacted to read: 
COMMITTEE AMENDMENT 
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2, , 
COMMITIEE AMENDMENT 'A "to H.P. 313, L.D. 425 
§2847-R. Coverage for children's early intervention services 
1. Definition. For purposes of this section, "children's early intervention services" 
means services provided by licensed occupational therapists, physical therapists, speech-
language pathologists or clinical social workers working with children from birth to 36 
months of age with an identified developmental disability or delay as described in the 
federal Individuals with Disabilities Education Act, Part C, 20 United States Code, 
Section 1411, et seq. 
2. 
Required coverage. 
All group health insurance policies, contracts and 
certificates must provide coverage for children's early intervention services in accordance 
with this subsection. 
A. A referral from the child's primary care provider is required. 
B. The policy, contract or certificate may limit coverage to $3,200 per year for each 
child not to exceed $9,600 by the child's 3rd bil1hday. 
C. The policy, contract or certificate may contain provisions for maximum benefits 
and coinsurance and reasonable limitations, deductibles and exclusions to the extent 
that these provisions are not inconsistent with the requirements of this section. 
Sec. 4. 24-A MRSA §4258 is enacted to read: 
§4258. Coverage for children's early intervention services 
1. Definition. 
For purposes of this section, "children's early intervention services" 
means services provided by licensed occupational therapists, physical therapists, speech-
language pathologists or clinical social workers working with children from bit1h to 36 
months of age with an identified developmental disability or delay as described in the 
federal Individuals with Disabilities Education Act, Part C, 20 United States Code, 
Section 1411, et seq. 
2. Required coverage. All individual and group health maintenance organization 
policies, contracts and cel1ificates must provide coverage for children's early intervention 
services in accordance with this subsection. 
A. A referral from the child's primary care provider is required. 
B. The policy, contract or certificate may limit coverage to $3,200 per year for each 
child not to exceed $9,600 by the child's 3rd birthday. 
C. The policy, contract or certificate may contain provisions for maxinium benefits 
and coinsurance and reasonable limitations, deductibles and exclusions to the extent 
that these provisions are not inconsistent with the requirements of this section. 
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 1,2011. For purposes ofthisAct, all contracts are deemed to be renewed 
no later than the next yearly anniversary of the contract date.' 
COMMITTEE AMENDMENT 
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COMMI~TEE AMENDMENT "A " 
to I-H. 313, L.D. 425 
SUMMARY 
This amendment changes the application clause of the bill so it will apply to all 
individual and group health insurance policies, contracts and certificates issued or 
renewed on or after January 1,2011. 
This amendment also reallocates the statutory provisions contained in the bill. 
FISCAL;\OTE HEQL!RED 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 02119/10 wac 
LD425 
LR 962(02) 
An Act To Require Private Insurance Coverage for Certain Services for Children with Disabilities 
FiscaJ Note for BiIJ as Amended by Committee Amendment 'A" 
Committee: Insurance and Financial Services 
Fiscal Detail and Notes 
FiscaJ Note Required: Yes 
Fiscal Note 
Potential future biennium cost increase - AlI Funds 
Potential future biennium savings - General Fund 
Potential future biennium savings - Federal Funds 
Assumes requiring individual and group health insurance policies and health maintenance organization contracts to 
provide coverage for early intervention services for children from birth to 3 years of age up to $3,200 per year per 
child up to a maximum of $9,600 by the child's 3rd birthday would result in potential costs to the State Employee 
Health Benefit Plan and potential savings to the MaineCare program in the Department of Health and Human Services 
and to the Child Development Services program in the Department of Education. Given the bilI as amended would 
apply to policies and contracts issued or renewed on or after January 1,2011, any costs or savings to State programs 
are expected to be minor for the current biennium. 
Estimates of the potential future biennium cost to the State Employee Health Benefit Plan are consistent with the 
Bureau of Insurance report to the Insurance and Financial Services Committee that estimated a cost of $0.22 per 
member per month, resulting in a total estimated annual cost to the plan of $84,500, with a resulting General Fund 
impact of approximately $31,900 per year and a Highway Fund impact of approximately $12,400 per year. 
Preliminary estimates of the potential future biennium savings to the MaineCare program range from the $250,000 per 
year included in the Bureau ofInsurance report to approximately $300,000 per year based on Department of Health 
and Human services estimates, with the resulting savings to the General Fund in the range of $90,500 to $108,600 per 
year (assuming a 63.80% federal match). 
' 
Potential future biennium'savings to the Child Development Services program in the Department of Education cannot 
be determined. 
LR0962(02) - Fiscal Note - Page 1 of 1 
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