An Act To Provide Access to Fertility Care
Maine Legislature, Session 130, LD 1539
Committee Amendment CA_A_SA_A_S566 (Senate)

SENATE AMENDMENT" A "to COMMITTEE AMENDMENT "A" to H.P. 1144, 
L.D. 1539, "An Act To Provide Access to Fertility Care" 
Amend the amendment in the first paragraph after the title in the last line (page 1, line 
in amendment) by striking out the following: "§4320-R" and inserting the following: 
'§4320-S' 
Amend the amendment in the 2nd paragraph after the title in the last line (page 1, line 
in amendment) by striking out the following: "§4320-R" and inserting the following: 
'§4320-S' 
Amend the amendment by inserting after the 4th paragraph after the title the following: 
'Amend the bill in section 1 in §4320-Q in subsection 2 in the 2nd line (page 1, line 40 
in L.D.) by inserting after the following: "subsection" the following: 'and as set forth in 
rules adopted by the bureau' 
Amend the bill in section 1 in §4320-Q in subsection 2 by striking out all of the first 
blocked paragraph (page 2, lines 2 to 8 in L.D.). 
Amend the bill in section 1 in §4320-Q by striking out all of subsection 3 (page 2, lines 
to 34 in L.D.) and inserting the following: 
'3. Limitations on coverage. A health plan that provides coverage for the services 
required by this section may include reasonable limitations to the extent that these 
limitations are not inconsistent with the following requirements and rules adopted by the 
bureau. 
A. A carrier may not impose a waiting period. 
B. A carrier may not use any prior diagnosis or prior fertility treatment as a basis for 
excluding, limiting or otherwise restricting the availability of coverage required by this 
section. 
C. A carrier may not impose any limitations on coverage for any fertility services 
based on an enrollee's use of donor gametes, donor embryos or surrogacy. 
D. A carrier may not impose different limitations on coverage for, provide different 
benefits to or impose different requirements on a class of persons protected under Title 
5, chapter 337 than those of other enrollees. 
SENATE AMENDMENT 
<?-,.o<o 
SENATE AMENDMENT" A "to COMMITTEE AMENDMENT "A" to H.P. 1144, L.D. 1539 ( $ -c:kf.tJ.) 
E. Any limitations imposed by a carrier must be based on an enrollee's medical history 
and clinical guidelines adopted by the carrier. Any clinical guidelines used by a carrier 
must be based on current guidelines developed by the American Society for 
Reproductive Medicine, its successor organization or a comparable organization, must 
cite with specificity any data or scientific reference relied upon, must be maintained in 
written form and must be made available to an enrollee in writing upon request.' 
Amend the bill in section 1 in §4320-Q by striking out all of subsection 5 (page 2, lines 
to 41 in L.D.) and inserting the following: 
'5. Rules. The superintendent may adopt rules to implement the requirements of this 
section, including, without limitation, cost-sharing, benefit design and clinical guidelines. 
In adopting rules under this subsection, the superintendent shall consider the clinical 
guidelines developed by the American Society for Reproductive Medicine, its successor 
organization or a comparable organization. Rules adopted pursuant to this subsection are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.' 
Amend the bill by inserting after section 1 the following: 
'Sec. 2. Evaluation. Upon consultation with the United States Department of Health 
and Human Services, Centers for Medicare and Medicaid Services, the Superintendent of 
Insurance shall evaluate whether the coverage required by the Maine Revised Statutes, Title 
24-A, section 4320-S can be incorporated as part of the essential health benefit package as 
defined in Title 24-A, section 4320-D or whether the federal Centers for Medicare and 
Medicaid Services would determine that the transfer of costs defrayed by the State to the 
federal Centers for Medicare and Medicaid Services pursuant to 42 United States Code, 
Section 18031 ( d)(3 )(B) would be required. The superintendent shall report by December 
31, 2022 to the joint standing committee of the Legislature having jurisdiction over health 
coverage, insurance and financial services matters concerning its consultation with the 
federal Centers for Medicare and Medicaid Services and the outcome of that consultation. 
The joint standing committee of the Legislature having jurisdiction over health coverage, 
insurance and financial services matters may report out a bill based on the evaluation under 
this section to the First Regular Session of the 131st Legislature.' 
Amend the bill in section 2 in the 3rd line (page 3, line 1 in L.D.) by striking out the 
following: "2023" and inserting the following: '2024' ' 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment revises language concerning required coverage, clinical guidelines 
developed by the American Society for Reproductive Medicine and limitations on coverage 
and allows the Superintendent of Insurance to adopt routine technical rules to implement 
the provisions of this legislation. It requires the Superintendent of Insurance to consult 
with the United States Department of Health and Human Services, Centers for Medicare 
and Medicaid Services to evaluate whether fertility benefits may be part of the essential 
health benefit package that is required under all health insurance plans in the State and to 
report to the joint standing committee of the Legislature having jurisdiction over health 
coverage, insurance and financial services matters by December 31, 2022. The joint 
standing committee is authorized to report out a bill to the First Regular Session of the 
SENATE AMENDMENT 
SENATE AMENDMENT" fl-" to COMMITTEEAMENDMENT"A" to H.P. 1144, L.D. 1539 ( $-5l,alt..) 
131st Legislature. The amendment also changes the application date in the bill to January 
1, 2024. 
/f . 
SPONSOREDBY: ~flJ--=:== 
/1 
'--.,L 
(Senator SANBORN, H.) 
COUNTY: Cumberland 
FISCAL NOTE REQUIREt. 
(See attached) 
SENATE AMENDMENT 
Approved: 04/15/22 feac;. 
LD 1539 
LR884(04) 
An Act To Provide Access to Fertility Care 
Fiscal Note for Senate Amendment ''fl.' to Committee Amendment "A" L 'S-::il.ak) 
Sponsor: Sen. Sanborn of Cumberland 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
Future biennium cost savings - All Funds 
FY 2021-22 
FY 2022-23 
$0 
$0 
$0 
$0 
$0 
$0 
$0 
$0 
Projections 
FY2023-24 
($174,818) 
($61,542) 
($174,818) 
($61,542) 
Projections 
FY2024-25 
$0 
$0 
$0 
$0 
This amendment will decrease the future year cost of the bill to the State Employee Health Plan (SEHP), eliminating 
the estimated costs in FY 2023-24. The impact on costs to the SEHP in FY 2024-25 cannot be determined at this time. 
Additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulations are assumed 
to be minor and can be absorbed within existing budgeted resources. 
LR0884(04) - Fiscal Note - Page 1 of 1