An Act To Require Health Insurers To Provide Coverage for Nutritional Wellness and Prevention Measures and Products
Maine Legislature, Session 124, LD 0782
Committee Amendment CA_A_H283 (House)
Amends: 24-A MRSA §4316

COMMITTEE AMENDMENT "A" to H.P. 533, L.D. 782, Bill, "An Act To 
Require Health Insurers To Provide Coverage for Nutritional Wellness and Prevention 
Measures and Products" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Require Health Insurers To Provide Coverage for Certain Medically 
Necessary Liquid Nutrition Therapy' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following:' 
'Sec. 1. 24-A MRSA §4316 is enacted to read: 
§4316. Coverage for liquid nutrition therapy 
1. Required coverage. A carrier shall provide coverage and reimburse for liquid 
nutrition therapy for home use that is medically necessary health care as defined in 
section 430 I-A, subsection 10-A and prescribed by the enrollee's physician. A licensed 
physician may be required to confirm and document ongoing medical necessity at least 
annually. 
2. Required diagnosis. Coverage for liquid nutrition therapy must be provided 
when proven effective as a disease-specific regimen for an enrollee diagnosed through 
medical evaluation with a chronic illness or condition. including but not limited to: 
A. Crohn's disease; 
B. 
Disorders of gastrointestinal motility such as chronic intestinal pseudo-
obstruction; 
C. Gastroesophageal reflux disease with failure to thrive; 
D. Severe food allergies that if left untreated will cause malnourishment, chronic 
physical disability, mental retardation or death; or 
E. Fibromyalgia. 
COMMITTEE A'MENDMENT 
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COMMIITEE AMENDMENT 'A" to H.P. 533, L.D. 782 
3. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State. 
For purposes of this section, all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
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 1,2010. For purposes of this Act, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date. 
Sec. 3. Exempt from Bureau of Insurance review. Notwithstanding the 
Maine Revised Statutes, Title 24-A, section 2752, this Act is enacted without review and 
evaluation by the Department of Professional and Financial Regulation, Bureau of 
Insurance. 
Sec. 4. 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 
liquid nutrition therapy for persons with a chronic illness. 
GENERAL FUND 
Personal Services 
GENERAL FUND TOTAL 
IDGHWAYFUND 
Personal Services 
HIGHWAY FUND TOTAL 
2009-10 
$0 
$0 
2009-10 
$0 
$0 
2010-11 
$85,244 
$85,244 
2010-11 
$33,937 
$33,937 
SUMMARY 
This amendment replaces the bill and is the minority report of the committee. The 
amendment requires health insurance coverage for medically necessary liquid nutrition 
therapy for persons with chronic illnesses. The amendment applies to all individual and 
group policies issued or renewed on or after January 1, 2010. 
This amendment also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 05/04/09 Mac:.. 
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LD 782 
LR 1428(02) 
An Act To Require Health Insurers To Provide Coverage for Nutritional Wellness and Prevention 
Measures and Products 
Fiscal Note for Bill as Amended by Committee Amendment 4" 
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 
2009-10 
$0 
$0 
$0 
$0 
2010-11 
$85,244 
$33,937 
$85,244 
$33,937 
Projections 
2011-12 
$90,358 
$35,973 
$90,358 
$35,973 
Projections 
2012-13 
$95,780 
$38,131 
$95,780 
$38,131 
Requiring coverage for medically necessary liquid nutrition therapy for persons with a chronic illness will increase 
health insurance premium costs to the State effective with the contract year beginning July 1, 2010. The additional 
employer costs across all funds to the state employee health insurance program is estimated to be approximately 
$198,000 for fiscal year 2010-11. 
A General Fund appropriation of $85,244 in 2010-11 and a Highway Fund allocation of $33,937 in 2010-1 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 req1,.lire 
increased allocations as recommended by the State Budget Officer and approved by the Governor. 
Any additional costs to the Bureau of Insurance in ~he 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. 
LR1428(02) - Fiscal Note - Page I of 1