An Act To Make Records of External Review Proceedings Overseen by the Bureau of Insurance Confidential
Maine Legislature, Session 126, LD 0648
Committee Amendment CA_A_S113 (Senate)
Amends: 24-A MRSA §4312

COMMITTEE AMENDMENT .-A " to S.P. 239, L.D. 648, Bill, "An Act To Make 
Records of External Review Proceedings Overseen by the Bureau of Insurance 
Confidential" 
Amend the bill by striking ou~ everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §4312, sub-§7-A is enacted to read: 
7-A. 
Confidentiality. Except as provided in this subsection, all records of the 
bureau or an independent review organization relating to an external review request or 
\ 
external review proceeding are confidential and not a public record under Title 1, chapter 
11., 
A. 
A party to an external review may obtain from the independent review 
organization a transcript or recording of the external review hearing and a copy of 
any evidence introduced by the opposing party. 
B. 
The superintendent shall disseminate to the Legislature and to the public 
aggregate information related to external reviews conducted by independent review 
organizations on an annual basis, including: 
(1) The number of external review requests by carrier, the number of decisions in 
favor of the enrollee, the number of decisions upholding the carrier's benefit 
determination and the number of external review requests resolved prior to the 
issuance of a decision; and 
(2) The categories of external review requests by carrier. The categories may not 
include personally identifiable information or specific medical condition. The 
categories must include, but are not limited to, medical necessity, out-of-network 
referrals, inpatient care, behavioral health, prescription drugs and experimental or 
investigational treatment,' 
COMMI7-TEE AMENDMENT 
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'C:> 
COMMITTEE AMENDMENT" A" to S.P. 239, L.D. 648 
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SUMMARY 
This amendment replaces the bill. The amendment protects the confidentiality of 
records of an external review proceeding arranged by the Department of Professional and 
Financial Regulation, Bureau of Insurance concerning an insurance carrier's adverse 
health care treatment decision, but gives parties to an external review proceeding the right 
to obtain a transcript or recording of the external review hearing and a copy of any 
evidence. The amendment also requires the Superintendent of Insurance to disseminate 
aggregate information relating to external review decisions to the Legislature and the 
public on an annual basis. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/06/13 ;tvac 
LD648 
LR 565(02) 
An Act To Make Records of External Review Proceedings Overseen by the Bureau of Insurance 
Confidential 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee AmendmentA.'{S - ,,3 ) 
Committee: Insurance and Financial Services 
Fis4:al Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Additional costs to the Bureau of Insurance in th,e Department of Professional and Financial Regulation are expected 
to be minor and can be absorbed within existing budgeted resources. 
LR0565(02) - Fiscal Note - Page 1 of 1