An Act To Improve Outcomes for Persons with Limb Loss
Maine Legislature, Session 130, LD 1003
Committee Amendment CA_A_H863 (House)
Amends: 24-A MRSA §4315

COMMITTEE AMENDMENT "H'" to H.P. 741, L.D. 1003, "An Act To Improve 
Outcomes for Persons with Limb Loss" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA §4315, sub-§2, as amended by PL 2003, c. 688, Pt. I, §1, is 
further amended to read: 
2. Required coverage. A carrier shall provide coverage for prosthetic devices in all 
health plans that, at a minimum, equals, except as provided in subsection 8, the coverage 
and payment for prosthetic devices provided under federal laws and regulations for the 
aged and disabled pursuant to 42 United States Code, Sections 1395k, 13951 and 1395m 
and 42 Code of Federal Regulations, Sections 414.202, 414.210, 414.228 and 410.100. 
Covered benefits must be provided for a prosthetie devise determined by the e11Follee's 
provider, in aecordance \Yith section 4301 A, subseetion 10 A., to be the most apprnpriate 
model that adequately meets the medical needs of the enrollee,l 
A. A prosthetic device determined by the enrollee's provider, in accordance with 
section 4301-A, subsection 10-A, to be the most appropriate model that adequately 
meets the medical needs of the enrollee; and 
B. With respect to an enrollee under 18 years of age, in addition to coverage of a 
prosthetic device required by paragraph A, a prosthetic device determined by the 
enrollee's provider, in accordance with section 4301-A. subsection 10-A, to be the most 
appropriate model that meets the medical needs of the enrollee for recreational 
purposes, as applicable, to maximize the enrollee's ability to ambulate, run, bike and 
swim and to maximize upper limb function. 
Sec. 2. 24-A MRSA §4315, sub-§6, as amended by PL 2009, c. 603, §1 and 
affected by §2, is further amended to read: 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT "~o H.P. 741, L.D. 1003 
6. Exclusions. Coverage Except as provided in subsection 2, paragraph B for an 
enrollee under 18 years of age, coverage is not required pursuant to this section for a 
prosthetic device that is designed exclusively for an athletic purposes purpose. 
Sec. 3. 24-A MRSA §4315, sub-§9 is enacted to read: 
9. Report. No later than June 30, 2027, each carrier that issues a health plan subject 
to this section shall report to the superintendent on its experience pursuant to this section 
for plan years 2023, 2024, 2025 and 2026. The report must be in a form prescribed by the 
superintendent and must include the number of claims and the total amount of claims paid 
in this State for the services required by this section. The superintendent shall aggregate 
this data by plan year in a report and submit the report to the joint standing committee of 
the Legislature having jurisdiction over health coverage and insurance matters no later than 
November 1, 2027. 
Sec. 4. No addition to State's essential health benefits; legislative finding. 
The Legislature finds that the requirements of this Act do not constitute an addition to the 
State's essential health benefits that requires defrayal of costs by the State pursuant to 42 
United States Code, Section 18031(d)(3)(B) because the requirements clarify that the law 
requiring a health insurance carrier to provide coverage for prosthetic devices to meet the 
medical needs of an enrollee under 18 years of age includes a prosthetic device designed 
to meet the enrollee's medical needs for recreational purposes. 
Sec. 5. 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, 2023. For purposes of this Act, all contracts are deemed to be renewed 
no later than the next yearly anniversary of the contract date.' 
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, health insurance carriers are 
required to provide coverage for a prosthetic device designed to meet an enrollee's medical 
needs. The amendment requires a carrier to provide coverage to enrollees under 18 years 
of age for a prosthetic device designed to meet an enrollee's medical needs for recreational 
purposes. The requirement applies to all health plans issued or renewed on or after January 
1, 2023. The amendment requires carriers to report to the Superintendent of Insurance on 
their claims experience with providing the covered services after 4 years, and the 
superintendent is required to report to the joint standing committee of the Legislature 
having jurisdiction over health coverage and insurance matters. 
The amendment also includes lm1guage stating the Legislature's finding that the 
changes are not an addition to the State's essential health benefits that would require the 
State to defray costs pursuant to the federal Patient Protection and Affordable Care Act. 
FISCAL NOTE REQUIRED 
(S~e attached} 
COMMITTEE AMENDMENT 
Approved: 03/24/22 ;:k?ae. 
LD 1003 
LR 1214(02) 
An Act To Improve Outcomes for Persons with Limb Loss 
Fiscal Note for Bill as Amended by Committee Amendment 11/f{j-f 75(;3) 
Committee: Health Coverage, Insurance and Financial Services 
tt 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 increase - All Funds 
FY 2021-22 
FY 2022-23 
$0 
$0 
$0 
$0 
$0 
$0 
$0 
$0 
Projections 
FY 2023-24 
$9,919 
$3,492 
$9,919 
$3,492 
Projections 
FY 2024-25 
$10,415 
$3,666 
$10,415 
$3,666 
Requiring health insurance carriers to provide coverage to enrollees under 18 years of age for one prosthetic device to 
meet an enrollee's medical needs for the purpose ofrecreation will increase General Fund costs to the State Employee 
Health Plan beginning in the plan year that starts July 1, 2023 by $9,919 in fiscal year 2023-24. The bill will also 
increase Highway Fund costs by $3,492 beginning in fiscal year 2023-24. These estimates are based on the 
assumption that this required coverage will increase costs to the plan by $0.08 per member per month (PMPM). 
LR1214(02) - Fiscal Note - Page 1 of 1