An Act Regarding Targets for Health Plan Investments in Primary Care and Behavioral Health
Maine Legislature, Session 130, LD 1196
Committee Amendment CA_A_H911 (House)
Amends: 24-A MRSA §6903, 24-A MRSA §6951, 24-A MRSA §4303

COMl\1ITTEE AMENDMENT " A,, to H.P. 874, L.D. 1196, "An Act Regarding 
Targets for Health Plan Investments in Primary Care and Behavioral Health" 
Amend the bill by striking out the title and substituting the following: 
'An Act Regarding Reporting on Spending for Behavioral Health Care Services and 
To Clarify Requirements for Credentialing by Health Insurance Carriers' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'PART A 
Sec. A-1. 24-A MRSA §6903, sub-§1-A is enacted to read: 
1-A. Behavioral health care. "B'ehavioral health care" means services to address 
mental health and substance use conditions. 
Sec. A-2. 24-A MRSA §6951, sub-§13 is enacted to read: 
13. Behavioral health care reporting.• Beginning Janua1y 15, 2023 and annually 
thereafter, the forum shall submit to the Department of Health and Human Services and the 
joint standing committee of the Legislature having jurisdiction over health coverage and 
health insurance matters a report on behavioral health care spending using claims data from 
the Maine Health Data Organization and information on the methods used to reimburse 
behavioral health care providers requested annually from payors. 
As used in this 
subsection, "payor" has the same meaning as in Title 22, section 8702, subsection 8. The 
report must include: 
A. Of their respective total medical expenditures, the percentage paid for behavioral 
health care by commercial insurers, the MaineCare program, Medicare, the 
organization that administers health insurance for state employees and the Maine 
Education Association benefits trust and the average percentage of total medical 
expenditures paid for behavioral health care across all payors; 
COMMITTEE AMENDMENT 
;\.:- ' -
COMMIITEEAMENDMENT'A "to H.P. 874,L.D.1196 
B. The total behavioral health care-related nonclaims-based payments and associated 
member months; 
C. The total payments associated with substance use disorder services that are redacted 
from the payor's claims data submissions to the Maine Health Data Organization as 
required under 42 Code of Federal Regulations, Part 2, the methods used to redact the 
substance use disorder claims, the specific code lists that are used for procedure codes, 
revenue codes and diagnosis codes, provider types and any other detail on the claim 
that is required to select the substance use disorder redacted claim: and 
D. The methods used by commercial insurers, the MaineCare program, Medicare, the 
organization that administers health insurance for state employees and the Maine 
Education Association benefits trust to pay for behavioral health care. 
Within 60 days of a request from the Maine Health Data Organization, a pay or shall provide 
the supplemental datasets specific to payments for behavioral health care services 
necessary to provide the information required in paragraphs B and C. In its request to a 
payor, the organization shall specify the time period for which the data is requested and 
define the datasets requested to ensure uniformity in the data submitted by payors. 
Sec. A-3. Maine Quality Forum to conduct health spending reporting 
study. The Maine Quality Forum, established in the Maine Revised Statutes, Title 24-A, 
section 6951, shall consult with other state and national agencies and organizations to 
determine the best practices for reporting spending on behavioral health care by insurers. 
For purposes of this section, "behavioral health care" means services to address mental 
health and substance use conditions. 
PARTB 
Sec. B-1. 24-A MRSA §4303, sub-§2, ~' as amended by PL 2015, c. 84, §1, is 
further amended to read: 
D. A carrier shall make credentialing decisions, including those granting or denying 
credentials, within 60 days of receipt of a completed credentialing application from a 
provider. The time period for granting or denying credentials may be extended upon 
written notifieation from tho earrier 1.vithin 60 days following submission of a 
eompleted application stating that information eontainod in the applieation requires 
additional time for verification. All credentialing decisions must be made within 180 
days of roeoipt of a eompletod application. For the purposes of this paragraph, an 
application is completed if the application includes all of the information required by 
the uniform credentialing application used by carriers and providers in this State, such 
attachments to that application as required by the carrier at the time of application and 
all corrections required by the carrier. A Within 30 days of initial receipt of a 
credentialing application, a carrier shall review the entire application before returning 
and, if it is incomplete, shall return it to the provider for corrections with a 
comprehensive list of all corrections needed at the time the application is first returned 
to the provider. A carrier may not require that a provider have a home address within 
the State before accepting an application. A carrier that is unable to make a 
credentialing decision on a completed credentialing application within the 60-day 
period as required in this paragraph shall notify the bureau in writing prior to the 
expiration of the 60-day period on that application and request authorization for an 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 874, L.D. 1196 
extension on that application. A carrier that requests an extension shall also submit to 
the bureau an explanation of the reasons why the credentialing decision on an 
application is taking longer than is permitted or, if the problem is not specific to a 
particular application, a written remediation plan to bring the carrier's credentialing 
practices in line with the 60-day limit in this paragraph. 
Sec. B-2. Bureau of Insurance review. The Department of Professional and 
Financial Regulation, Bureau of Insurance shall review the requirements in Bureau of 
Insurance rule Chapter 850, Health Plan Accountability, related to the verification of 
information on credentialing applications from health care practitioners and determine 
whether amendments must be made to the rule's requirements in order to improve the 
ability of carriers to make a credentialing decision within the 60-day period in accordance 
with the Maine Revised Statutes, Title 24-A, section 4303, subsection 2, paragraph D 
without an impact on quality standards or accreditation standards. Notwithstanding Title 
24-A, section 4309, any amendments to Bureau of Insurance rule Chapter 850 adopted 
following the review required by this section are routine technical rules as defined in Title 
5, chapter 375, subchapter 2-A. 
Sec. B-3. Appropriations and allocations. The following appropriations and 
allocations are made. 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
Insurance - Bureau of 0092 
Initiative: Provides funding for one Senior Insurance Examiner position and related All 
Other costs to examine insurer requests related to accreditation of health care providers. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2021-22 
0.000 
$0 
$0 
$0 
2022-23 
1.000 
$121,132 
$10,803 
$131,935 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill. 
Under current law, the Maine Quality Forum has been required to submit an annual 
report on primary care spending since 2020. Part A of the amendment requires the Maine 
Quality Forum to submit an annual report, beginning January 15, 2023, for behavioral 
health care spending based on claims data reported to the Maine Health Data Organization 
and information on methods of reimbursement reported by insurers. 
Part B of the amendment requires carriers to make all credentialing decisions on a 
completed application within 60 days and requires an insurance carrier to notify a health 
care provider if an application is incomplete and needs correction within 3 0 days of initial 
receipt of an application. A carrier that is unable to make a credentialing decision on a 
COMMITTEE AMENDMENT 
COMMITTEE AMEND'MENT •A" to H.P. 874, L.D. 1196 
completed credentialing application within the 60-day period must notify the Department 
of Professional and Financial Regulation, Bureau of Insurance in writing prior to the 
expiration of the 60-day period on that application and request authorization for an 
extension on that application. A carrier that requests an extension must also submit to the 
bureau an explanation of the reasons why the credentialing decision on an application is 
taking longer than is permitted or, if the problem is not specific to a paiticular application, 
a written remediation plan to bring the carrier's credentialing practices in line with the 60-
day limit. 
Part B also requires the Bureau of Insurance to review the requirements in Bureau of 
Insurance rule Chapter 850, Health Plan Accountability, related to the verification of 
information on credentialing applications from health care practitioners and determine 
whether amendments must be made to the requirements for carriers to verify certain 
information on a credentialing application in order to improve the ability of carriers to make 
a credentialing decision within the 60-day period without an impact on quality standards 
or accreditation standards. It also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/25/22 feae.. 
LD 1196 
LR 740(02) 
An Act Regarding Targets for Health Plan Investments in Primary Care and Behavioral Health 
Fiscal Note for Bill as Amended by Committee Amendment•:)/, ( H~~f}) 
Committee: Health Coverage, Insurance and Financial Services 
Appropriations/Allocations 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY2021-22 
FY 2022-23 
$0 
$131,935 
Projections 
FY 2023-24 
$135,458 
Projections 
FY 2024-25 
$143,298 
The bill provides an allocation of Other Special Revenue Funds of $131,935 in fiscal year 2022-23 to the Bureau of 
Insurance in the Department of Professional and Financial Regulation for one Senior Insurance Examiner position 
and related All Other costs to investigate insurer requests related to accreditation of health care providers. Any 
additional costs to the Department of Health and Human Services from the provisions of this bill are expected to be 
minor and can be absorbed within existing budgeted resources. 
LR0740(02) - Fiscal Note - Page 1 of 1