An Act Regarding the Process for Obtaining Prior Authorization for Health Insurance Purposes
Maine Legislature, Session 129, LD 0705
Committee: Health Coverage, Insurance and Financial Services
Sponsors: GRATWICK, HYMANSON, CARPENTER, CLAXTON, MOORE, JORGENSEN, MEYER, PERRY
Amends: 24-A MRSA §4304

Legislative Document
No. 705
S.P. 218
In Senate, February 11, 2019
An Act Regarding the Process for Obtaining Prior Authorization for 
Health Insurance Purposes
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator GRATWICK of Penobscot.
Cosponsored by Representative HYMANSON of York and
Senators: CARPENTER of Aroostook, CLAXTON of Androscoggin, MOORE of Washington, 
SANBORN, H. of Cumberland, SANBORN, L. of Cumberland, Representatives: 
JORGENSEN of Portland, MEYER of Eliot, PERRY of Calais.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4304, sub-§2, as amended by PL 1999, c. 742, §12, is 
further amended to read:
2.  Prior authorization of nonemergency services.  Requests by a provider for prior 
authorization of a nonemergency service must be answered by a carrier within 2 business 
days 48 hours.  Both the provider and the enrollee on whose behalf the authorization was 
requested must be notified by the carrier of its determination.  If the information 
submitted is insufficient to make a decision, the carrier shall notify the provider within 2 
business days of the additional information necessary to render a decision.  If the carrier 
determines that outside consultation is necessary, the carrier shall notify the provider and 
the enrollee for whom the service was requested within 2 business days.  The carrier shall 
make a good faith estimate of when the final determination will be made and contact the 
enrollee and the provider as soon as practicable.  Notification requirements under this 
subsection are satisfied by written notification postmarked within the time limit specified.
Sec. 2.  24-A MRSA §4304, sub-§§2-A and 2-B are enacted to read:
2-A.  Medical services exempt from prior authorization.  A carrier may not 
subject medication-assisted treatment for opioid use disorder to prior authorization.
2-B.  Electronic transmission of prior authorization requests.  Beginning no later 
than January 1, 2020, if a health plan provides coverage for prescription drugs, the carrier 
must accept and respond to prior authorization requests in accordance with subsection 2 
through a secure electronic transmission using standards adopted by a national council for 
prescription drug programs for electronic prescribing transactions.  Beginning no later 
than July 1, 2020, a carrier must accept and respond to prior authorization requests for 
medical services in accordance with subsection 2 through a standard secure electronic 
transmission under the federal Health Insurance Portability and Accountability Act of 
1996, Public Law 104-191.  For the purposes of this subsection, transmission of a 
facsimile through a proprietary payer portal or by use of an electronic form is not 
considered electronic transmission.
SUMMARY
This bill amends the prior authorization process for health insurance carriers.  It 
reduces the time frame for a carrier's response to a prior authorization request and it 
exempts medication-assisted treatment for opioid use disorder from prior authorization 
requirements.
The bill also requires a health insurance carrier to develop an electronic transmission 
system for prior authorization of prescription drug orders by January 1, 2020 and for 
medical services by July 1, 2020.