An Act To Protect Vision Care Patients and Providers
Maine Legislature, Session 127, LD 0865
Committee Amendment CA_A_S114 (Senate)
Amends: 24-A MRSA §4314

COMMITTEE AMENDMENT" A "to S.P. 310, L.D. 865, Bill, "An Act To Protect 
Vision Care Patients and Providers" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §4314, sub-§l, ~~C to I are enacted to read: 
C. "Contractual discount" means a percentage or other reduction from a provider's 
usual and customary rate for a covered service or covered material required under a 
participating provider agreement. 
D. "Covered material" means a material for which benefits are provided under a 
health plan that provides coverage for vision care or eye care services or a limited 
benefit vision insurance plan. 
E. "Covered service" means a service for which benefits are provided under a health 
plan that provides coverage for vision care or eye care services or a limited benefit 
vision insurance plan. 
F. "Limited benefit vision insurance plan" means a plan offered or administered by a 
carrier that covers only vision care or any other plan offered or administered by a 
carrier that includes vision care benefits and is not a health plan. 
G. 
"Materials" means ophthalmic devices, including, but not limited to, lenses, 
devices containing lenses, artificial intraocular lenses, ophthalmic frames and other 
lens mounting apparatuses, prisms, lens treatments and coating, contact lenses and 
prosthetic devices to correct, relieve or treat defects or abnonnal conditions of the 
human eye or its adnexa. 
H. "Services" means the professional work performed by an eye care provider. 
I. "Vision insurance" means a health plan that provides coverage for vision care or 
eye care services or a limited benefit vision insurance plan. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A "to S.P. 310, L.D. 865 
Sec. 2. 24-A MRSA §4314, sub-§3, as enacted by PL 2001, c. 408, §1 and 
affected by §2, is amended to read: 
3. Prohibitions. A carrier or a subsidiary or subcontractor of a carrier may not: 
A. 
Impose a deductible or coinsurance for eye care services that is greater than the 
deductible or coinsurance imposed for other health care services under a health plan; 
er 
B. 
Require an eye care provider to hold hospital privileges as a condition of 
participation as a provider under a health plan~~ 
C. Require in an agreement with an eye care provider that the eye care provider 
provide services or materials to an enrollee in a health plan that provides coverage for 
vision care or eye care services or a limited benefit vision insurance plan at a 
specified or limited fee unless the services or materials are a covered service or a 
covered material under the health plan or limited benefit vision insurance plan; 
D. Restrict or limit, directly or indirectly, in an agreement with an eye care provider, 
the eye care provider's choice of sources and suppliers of services or materials 
provided by the eye care provider to an enrollee or the optical laboratories used by 
the eye care provider; 
E. Change any term, contractual discount or reimbursement rate contained in an 
agreement with an eye care provider without notice to the eye care provider at least 
days before the change is implemented; 
F. Require in an agreement with an eye care provider that the eye care provider 
participate in other vision insurance as a condition of joining an insurer's provider 
network for a health plan that provides coverage for vision care or eye care services 
or a limited benefit vision insurance plan; or 
G. Enter into an agreement with an eye care provider that is longer than 2 years from 
the date the agreement is first signed. 
Sec. 3. 24-A MRSA §4314, sub-§6 is enacted to read: 
6. 
Enforcement. 
A violation of this section by a carrier or a subsidiary or 
subcontractor of a carrier is enforced by the superintendent under the authority granted by 
section 12-A. 
Sec. 4. Application. The requirements of this Act apply to contracts between an 
eye care provider and a carrier, as defined in the Maine Revised Statutes, Title 24-A, 
section 430l-A, subsection 3, or a subsidiary or subcontractor of a carrier executed or 
renewed on or after January 1,2016.' 
SU~Y 
This amendment replaces the bill. The amendment prohibits a carrier, as defined in 
the Maine Revised Statutes, Title 24-A, section 4301-A, subsection 3, or a subsidiary or 
subcontractor of a carrier from engaging in the following practices with regard to 
agreements with eye care providers: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A "to S.P. 310, L.D. 865 
1. Requiring that the eye care provider provide services or materials to an enrollee in 
a health plan that provides coverage for vision care or eye care services or a limited 
benefit vision insurance plan at a specified or limited fee unless the services or materials 
are a covered service or a covered material under the health plan or limited benefit vision 
insurance plan; 
2. Restricting or limiting the eye care provider's choice of sources and suppliers of 
services or materials provided by the eye care provider to an enrollee or the optical 
laboratories used by the eye care provider; 
3. Changing any term, contractual discount or reimbursement rate without notice to 
the eye care provider at least 60 days before the change is implemented; 
4. Requiring that the eye care provider participate in other vision insurance as a 
condition of joining an insurer's provider network for a health plan that provides coverage 
for vision care or eye care services or a limited benefit vision insurance plan; or 
5. Entering into any agreement that is longer than 2 years. 
The amendment stipulates that the provisions apply to contracts between an eye care 
provider and a carrier or a subsidiary or subcontractor of a carrier executed or renewed on 
or after January 1,2016. 
FISCAL ?\'"ort: RFQVJRED 
(S~t: uttuched) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 05/19/15 
;t1dczc 
LD865 
LR 1445(02) 
An Act To Protect Vision Care Patients and Providers 
Fiscal Note for Bill as Amended by Committee Amendment ''If' (S-Il~) 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the Department of Professional and Financial Regulation to adopt the changes in this bill are 
expected to be minor and can be absorbed within existing budgeted resources. 
The Department of Administrative and Financial Services does not believe this will have any direct impact on the 
claims or premiums paid by the Anthem vision plan for state employees. However, this could have an impact on the 
out-of-pocket expenditures for members insured by the State's plan. 
LR1445(02) - Fiscal Note - Page 1 of 1