An Act To Streamline Billing for Mental Health Services
Maine Legislature, Session 126, LD 1525
Committee: Insurance and Financial Services
Sponsors: EVES, LACHOWICZ
Amends: 24-A MRSA §1912, 24-A MRSA §2680, 24-A MRSA §2753, 24-A MRSA §2823-B, 24-A MRSA §4235

Legislative Document 
No. 1525 
H.P. 1098 
House of Representatives, May 9, 2013 
An Act To Streamline Billing for Mental Health Services 
(AFTER DEADLINE) 
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
205. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Speaker EVES of North Berwick. 
Cosponsored by Senator LACHOWICZ of Kennebec. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §1912, as amended by PL 2005, c. 97, §1, is further amended 
to read: 
§1912.  Standardized claim forms 
All administrators who administer claims and who provide payment or 
reimbursement for diagnosis or treatment of a condition or a complaint by a licensed 
health care practitioner must accept the current standardized claim form for professional 
services approved by the Federal Government and submitted electronically.  All 
administrators who administer claims and who provide payment or reimbursement for 
diagnosis or treatment of a condition or a complaint by a licensed hospital must accept 
the current standardized claim form for professional or facility services, as applicable, 
approved by the Federal Government and submitted electronically.  An administrator may 
not be required to accept a claim submitted on a form other than the applicable form 
specified in this section and may not be required to accept a claim that is not submitted 
electronically, except from a health care practitioner who is exempt pursuant to Title 24, 
section 2985.  All services provided by a health care practitioner in an office setting must 
be submitted on the standardized federal form used by noninstitutional providers and 
suppliers.  Services in a nonoffice setting may be billed as negotiated between the 
administrator and health care practitioner. For purposes of this section, "office setting" 
means a location where the health care practitioner routinely provides health 
examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether 
or not the office is physically located within a facility.  An administrator may not require 
the use of revised billing codes under the 5th edition of the Diagnostic and Statistical 
Manual of Mental Disorders by persons submitting claims under this section before 
January 1, 2014. 
Sec. 2.  24-A MRSA §2680, as amended by PL 2003, c. 469, Pt. D, §5 and 
affected by §9, is further amended to read: 
§2680.  Standardized claim form 
Administrators providing payment or reimbursement for diagnosis or treatment of a 
condition or a complaint by a licensed health care practitioner or licensed hospital shall 
accept the current standardized claim form for professional or facility services, as 
applicable, approved by the Federal Government and submitted electronically.  An 
administrator may not be required to accept a claim submitted on a form other than the 
applicable form specified in this section and may not be required to accept a claim that is 
not submitted electronically, except from a health care practitioner who is exempt 
pursuant to Title 24, section 2985.  An administrator may not require the use of revised 
billing codes under the 5th edition of the Diagnostic and Statistical Manual of Mental 
Disorders by persons submitting claims under this section before January 1, 2014. 
Sec. 3.  24-A MRSA §2753, as amended by PL 2005, c. 97, §2, is further amended 
to read: 
§2753.  Standardized claim forms 
All insurers providing individual medical expense insurance on an expense-incurred 
basis providing payment or reimbursement for diagnosis or treatment of a condition or a 
complaint by a health care practitioner must accept the current standardized claim form 
for professional services approved by the Federal Government and submitted 
electronically.  All insurers providing individual medical expense insurance on an 
expense-incurred basis providing payment or reimbursement for diagnosis or treatment of 
a condition or a complaint by a licensed hospital must accept the current standardized 
claim form for professional or facility services, as applicable, approved by the Federal 
Government and submitted electronically.  An insurer may not be required to accept a 
claim submitted on a form other than the applicable form specified in this section and 
may not be required to accept a claim that is not submitted electronically, except from a 
health care practitioner who is exempt pursuant to Title 24, section 2985.  All services 
provided by a health care practitioner in an office setting must be submitted on the 
standardized federal form used by noninstitutional providers and suppliers.  Services in a 
nonoffice setting may be billed as negotiated between the insurer and health care 
practitioner. For purposes of this section, "office setting" means a location where the 
health care practitioner routinely provides health examinations, diagnosis and treatment 
of illness or injury on an ambulatory basis whether or not the office is physically located 
within a facility.  An insurer may not require the use of revised billing codes under the 
5th edition of the Diagnostic and Statistical Manual of Mental Disorders by persons 
submitting claims under this section before January 1, 2014. 
Sec. 4.  24-A MRSA §2823-B, as amended by PL 2005, c. 97, §3, is further 
amended to read: 
§2823-B.  Standardized claim forms 
All insurers providing group medical expense insurance on an expense-incurred basis 
providing payment or reimbursement for diagnosis or treatment of a condition or a 
complaint by a licensed health care practitioner must accept the current standardized 
claim form for professional services approved by the Federal Government and submitted 
electronically.  All insurers providing group medical expense insurance on an expense-
incurred basis providing payment or reimbursement for diagnosis or treatment of a 
condition or a complaint by a licensed hospital must accept the current standardized claim 
form for professional or facility services, as applicable, approved by the Federal 
Government and submitted electronically.  An insurer may not be required to accept a 
claim submitted on a form other than the applicable form specified in this section and 
may not be required to accept a claim that is not submitted electronically, except from a 
health care practitioner who is exempt pursuant to Title 24, section 2985.  All services 
provided by a health care practitioner in an office setting must be submitted on the 
standardized federal form used by noninstitutional providers and suppliers.  Services in a 
nonoffice setting may be billed as negotiated between the insurer and health care 
practitioner. For purposes of this section, "office setting" means a location where the 
health care practitioner routinely provides health examinations, diagnosis and treatment 
of illness or injury on an ambulatory basis whether or not the office is physically located 
within a facility.  An insurer may not require the use of revised billing codes under the 
5th edition of the Diagnostic and Statistical Manual of Mental Disorders by persons 
submitting claims under this section before January 1, 2014. 
Sec. 5.  24-A MRSA §4235, as amended by PL 2005, c. 97, §4, is further amended 
to read: 
§4235.  Standardized claim forms 
All health maintenance organizations providing payment or reimbursement for 
diagnosis or treatment of a condition or a complaint by a licensed health care practitioner 
must accept the current standardized claim form for professional services approved by the 
Federal Government and submitted electronically.  All health maintenance organizations 
providing payment or reimbursement for diagnosis or treatment of a condition or a 
complaint by a licensed hospital must accept the current standardized claim form for 
professional or facility services, as applicable, approved by the Federal Government and 
submitted electronically.  A health maintenance organization may not be required to 
accept a claim submitted on a form other than the applicable form specified in this section 
and may not be required to accept a claim that is not submitted electronically, except 
from a health care practitioner who is exempt pursuant to Title 24, section 2985.  All 
services provided by a health care practitioner in an office setting must be submitted on 
the standardized federal form used by noninstitutional providers and suppliers.  Services 
in a nonoffice setting may be billed as negotiated between the health maintenance 
organization and health care practitioner. For purposes of this section, "office setting" 
means a location where the health care practitioner routinely provides health 
examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether 
or not the office is physically located within a facility.  A health maintenance 
organization may not require the use of revised billing codes under the 5th edition of the 
Diagnostic and Statistical Manual of Mental Disorders by persons submitting claims 
under this section before January 1, 2014. 
SUMMARY 
This bill provides that insurers, health maintenance organizations and other 
administrators of health insurance claims may not require persons submitting those 
claims before January 1, 2014 to use revised billing codes under the 5th edition of the 
Diagnostic and Statistical Manual of Mental Disorders released in May 2013.