An Act To Ensure Continued Coverage for Essential Health Care
Maine Legislature, Session 128, LD 1476
Committee: Insurance and Financial Services
Sponsors: McCREIGHT, CARSON, DENNO, DEVIN, GOLDEN, HERBIG, PARKER, RECKITT, SYLVESTER
Amends: 24-A MRSA §4320-A

Legislative Document
No. 1476
H.P. 1015
House of Representatives, April 18, 2017
An Act To Ensure Continued Coverage for Essential Health Care
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed.
ROBERT B. HUNT
Clerk
Presented by Representative McCREIGHT of Harpswell.
Cosponsored by Senator CARSON of Cumberland and
Representatives: DENNO of Cumberland, DEVIN of Newcastle, GOLDEN of Lewiston, 
HERBIG of Belfast, McCREA of Fort Fairfield, PARKER of South Berwick, RECKITT of 
South Portland, SYLVESTER of Portland.
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §4320-A, as enacted by PL 2011, c. 364, §34, is amended to 
read: 
§4320-A.  Coverage of preventive health services 
Notwithstanding any other requirements of this Title, a carrier offering a health plan 
subject to the federal Affordable Care Act in this State shall, at a minimum, provide 
coverage for and may not impose cost-sharing requirements for preventive services as 
required by the federal Affordable Care Act this section. 
1.  Preventive services.  A health plan must, at a minimum, provide coverage for: 
A.  The evidence-based items or services that have a rating of A or B in the 
recommendations of the United States Preventive Services Task Force or equivalent 
rating from a successor organization; 
B.  With respect to the individual insured, immunizations that have a 
recommendation from the American Academy of Pediatrics, the American Academy 
of Family Physicians or the American College of Obstetricians and Gynecologists or 
a successor organization; 
C.  With respect to infants, children and adolescents, evidence-informed preventive 
care and screenings provided for in the most recent version of the comprehensive 
guidelines for health supervision of infants, children and adolescents developed by 
the American Academy of Pediatrics or a successor organization; and 
D.  With respect to women, such additional preventive care and screenings not 
described in paragraph A, including: 
(1)  Well-woman preventive care; 
(2)  Contraception in accordance with subsection 2; 
(3)  Screening for breast cancer; 
(4)  Screening for cervical cancer; 
(5)  Screening for HIV; 
(6)  Screening for gestational diabetes; 
(7)  Folic acid supplementation; 
(8)  Breastfeeding services and supplies; 
(9)  Screening for interpersonal and domestic violence; 
(10)  Counseling for sexually transmitted infections; 
(11)  Breast cancer chemoprevention counseling; and 
(12)  Risk assessment for a BRCA gene mutation and genetic counseling or 
testing if necessary. 
2.  Contraceptive methods and services.  Notwithstanding sections 2756, 2840-A 
and 4247, a health plan must, at a minimum, provide coverage for all of the following 
contraceptive methods and services: 
A.  All contraceptive drugs, devices and other products approved by the federal Food 
and Drug Administration, including those prescribed by the enrollee's provider or as 
otherwise authorized under state or federal law.  If there is a therapeutic equivalent of 
a contraceptive drug, device or product approved by the federal Food and Drug 
Administration, coverage must include either the contraceptive drug, device or 
product originally prescribed and approved by the federal Food and Drug 
Administration or at least one of its therapeutic equivalents; 
B.  Voluntary sterilization procedures; 
C.  Patient education and counseling on contraception; and 
D.  Services related to the drugs, devices, products and procedures covered under this 
subsection, including, but not limited to, management of side effects, counseling for 
continued adherence and device insertion and removal. 
A health plan may not impose any restrictions or delays on the coverage of contraceptive 
methods and services required under this subsection. 
3.  Minimum interval.  The superintendent shall establish a minimum interval of not 
less than one year between the date on which a recommendation or guideline described in 
subsection 1 is issued and the plan year with respect to which the requirement in 
subsection 1 is effective with respect to the service described in the recommendation or 
guideline. 
4.  Review of preventive coverage recommendations.  On an annual basis 
beginning January 1, 2019, the superintendent shall review the preventive care items, 
services and screenings that have a rating of A or B in the recommendations of the United 
States Preventive Services Task Force, that are provided for in the comprehensive 
guidelines supported by the federal Department of Health and Human Services, Health 
Resources and Services Administration or that are recommended by the American 
Academy of Pediatrics, the American Academy of Family Physicians or the American 
College of Obstetricians and Gynecologists or a successor organization.  The 
superintendent shall identify whether there are any preventive care items, services or 
screenings that are not included in the minimum coverage provided by a health plan 
pursuant to this section and notify the joint standing committee of the Legislature having 
jurisdiction over health insurance matters.  The joint standing committee of the 
Legislature having jurisdiction over health insurance matters may report out legislation to 
any regular session of the Legislature to amend the requirements for minimum coverage 
under this section based on the report from the superintendent. 
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, 2018.  For purposes of this Act, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date. 
SUMMARY 
This bill incorporates current requirements under the federal Patient Protection and 
Affordable Care Act for coverage of preventive health services, including services for 
women, into state law.  The bill also requires coverage of certain contraceptive methods 
and services.  The bill directs the Superintendent of Insurance to annually review the 
recommendations and guidelines for coverage of preventive health services to identify 
any gaps in the minimum coverage provided by health plans and authorizes the joint 
standing committee of the Legislature having jurisdiction over health insurance matters to 
introduce legislation to update the requirements for minimum coverage.  The 
requirements apply to all individual and group health insurance policies and contracts 
issued or renewed on or after January 1, 2018.