An Act To Improve Access to Behavioral Health Services by Prohibiting Cost Sharing by Insurers
Maine Legislature, Session 130, LD 1822
Committee Amendment CA_A_H910 (House)
Amends: 24-A MRSA §4320-A, 24-A MRSA §4320-R

COMMITTEE AMENDMENT" A,, to H.P. 1355, L.D. 1822, "An Act To Improve 
Access to Behavioral Health Services by Prohibiting Cost Sharing by Insurers" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Improve Access to Behavioral Health Services by Limiting Cost Sharing 
by Insurers' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA §4320-A, sub-§3, as enacted by PL 2019, c. 653, Pt. C, §1, 
is amended to read: 
3. Primary health services. An individual or small group health plan with an effective 
date on or after from January 1, 2021 to December 31, 2022 must provide coverage without 
cost sharing for the first primary care office visit and first behavioral health office visit in 
each plan year and may not apply a deductible or coinsurance to the 2nd or 3rd primary 
care and 2nd or 3rd behavioral health office visits in a plan year. Any~ copayments 
for the 2nd or 3rd primary care and 2nd or 3rd behavioral health office visits in a plan year 
count toward the deductible. This subsection does not apply to a plan offered for use with 
a health savings account unless the federal Internal Revenue Service determines that the 
benefits required by this section are permissible benefits in a high deductible health plan as 
defined in the federal Internal Revenue Code, Section 223( c )(2). The superintendent shall 
conduct a study analyzing the effects of this subsection on premiums based on experience 
in plan years 2020 and 2021. The superintendent may adopt rules as necessary to address 
the coordination of the requirements of this subsection for coverage without cost sharing 
for the first primary care visit and the requirements of this section with respect to coverage 
of an annual well visit. Rules adopted pursuant to this subsection are routine technical rules 
as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 2. 24-A MRSA §4320-A, sub-§3-A is enacted to read: 
COMMITTEE AMENDMENT 
Ros 
COMMITTEE AMENDMENT ,A, to H.P. 1355, L.D. 1822 
3-A. Parity in cost sharing for primary care and behavioral health office visits; 
individual or small group health plan. An individual or small group health plan with an 
effective date on or after January 1, 2023 must provide coverage without cost sharing for 
the first primary care office visit and first behavioral health office visit in each plan year 
and may not apply a deductible or coinsurance to the 2nd or 3rd primary care and 2nd or 
3rd behavioral health office visits in a plan year. Any copayments for primary care office 
visits and behavioral health office visits in a plan year count toward the deductible. After 
the first behavioral health office visit, a health plan may not apply a copayment amount to 
a behavioral health office visit that is greater than the copayment for a primary care office 
visit. For the purposes of this subsection, "behavioral health office visit" means an office 
visit to address mental health and substance use conditions. This subsection does not apply 
to a plan offered for use with a health savings account unless the federal Internal Revenue 
Service determines that the benefits required by this section are permissible benefits in a 
high deductible health plan as defined in the federal Internal Revenue Code, Section 
223(c)(2). The superintendent may adopt rules as necessary to address the coordination of 
the requirements of this subsection for coverage without cost sharing for the first primary 
care visit and the requirements of this section with respect to coverage of an annual well 
visit. Rules adopted pursuant to this subsection are routine technical rules as defmed in 
Title 5, chapter 375, subchapter 2-A. 
Sec. 3. 24-A MRSA §4320-A, sub-§3-B is enacted to read: 
3-B. Parity in cost sharing for primary care and behavioral health office visits; 
group health plan. A group health plan, other than a small group health plan subject to 
subsection 3-A, with an effective date on or after January L 2023 must provide coverage 
without cost sharing for the first primary care office visit and first behavioral health office 
visit in each plan year. After the first behavioral health office visit, a health plan may not 
apply a copayment amount to a behavioral health office visit that is greater than the 
copayment for a primary care office visit. For the purposes of this subsection, "behavioral 
health office visit" means an office visit to address mental health and substance use 
conditions. This subsection does not apply to a plan offered for use with a health savings 
account unless the federal Internal Revenue Service determines that the benefits required 
by this section are permissible benefits in a high deductible health plan as defmed in the 
federal Internal Revenue Code, Section 223(c)(2). The superintendent may adopt rules as 
necessary to address the coordination of the requirements of this subsection for coverage 
without cost sharing for the first primary care visit and the requirements of this section with 
respect to coverage of an annual well visit. Rules adopted pursuant to this subsection are 
routine technical rules as defmed in Title 5, chapter 375, subchapter 2-A. 
Sec. 4. 24-A MRSA §4320-R is enacted to read: 
§4320-R. Implementation of federal mental health parity laws 
1. Nonguantitative treatment limitation; definition. For the purposes of this section, 
"nonquantitative treatment limitation" means a limitation that is not expressed numerically 
but otherwise limits the scope or duration of benefits for treatment. 
2. Compliance with federal mental health parity laws. A carrier offering a health 
plan in this State providing health coverage for mental health and substance use disorder 
services pursuant to sections 2749-C, 2842, 2843, 4234-A and 4320-D and Title 24, 
sections 2325-A and 2329 must meet the requirements of the federal Paul Wellstone and 
COMMITTEE AMENDMENT 
RoS1 
' 
COMMITTEE AMENDMENT "A" to H.P. 1355, L.D. 1822 
Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and any 
amendments to, and any federal guidance or regulations relevant to, that Act, including 45 
Code of Federal Regulations, Sections 146.136, 147.136, 147.160 and 156.115(a)(3). 
3. Implementation of federal mental health parity laws. The superintendent shall 
implement and enforce applicable provisions of the federal Paul Wellstone and Pete 
Domenici Mental Health Parity and Addiction Equity Act of 2008, and any amendments 
to and federal guidance or regulations relevant to that Act, including 45 Code of Federal 
Regulations, Sections 146.136, 147.136, 147.160 and 156.115(a)(3), by: 
A. Proactively ensuring compliance by insurers, health maintenance organizations and 
nonprofit hospital or medical service organizations that execute, deliver, issue for 
delivery, continue or renew individual policies or individual and group health care 
contracts; 
B. Evaluating all consumer or provider complaints regarding mental health and 
substance use disorder coverage for possible parity violations; 
C. Performing parity compliance market conduct examinations of carriers that execute, 
deliver, issue for delivery, continue or renew individual policies or individual and 
group health care contracts, particularly market conduct examinations that focus on 
nonquantitative treatment limitations, including, but not limited to, prior authorization, 
concurrent review, retrospective review, step therapy, network admission standards, 
reimbursement rates and geographic restrictions: and 
D. Requesting that carriers submit comparative analyses during the form review 
process demonstrating how they design and apply nonquantitative treatment limitation, 
both as written and in operation, for mental health and substance use disorder benefits 
as compared to how they design and apply nonquantitative treatment limitation, as 
written and in operation, for medical and surgical benefits. 
The superintendent may adopt rules, as authorized under section 212, as may be necessary 
to effectuate any provisions of the federal Paul Wellstone and Pete Domenici Mental Health 
Parity and Addiction Equity Act of 2008 that relate to the business of insurance. Rules 
adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 
375, subchapter 2-A. 
4. Reports to superintendent. As part of the report submitted to the superintendent, 
and subsequently reported by the superintendent to the Legislature, pursuant to section 
2749-C, subsection 4, section 2843, subsection 7, section 4234-A. subsection 10 and Title 
24, section 2325-A. subsection 8, a carrier shall submit the following information to the 
superintendent: 
A. A description of the process used to develop or select the medically necessary health 
care criteria for mental health and substance use disorder benefits and the process used 
to develop or select the medically necessary health care criteria for medical and surgical 
benefits: 
B. Identification of all nonquantitative treatment limitations that are applied to mental 
health and substance use disorder benefits and medical and surgical benefits within 
each classification of benefits. The report must include information demonstrating that 
each nonguantitative treatment limitation that applies to mental health and substance 
COMMITTEE AMENDMENT 
~os 
COMMITTEE AMENDMENT" 4, to H.P. 1355, L.D. 1822 
use disorder benefits also applies to medical and surgical benefits within any 
classification of benefits; and 
C. The results of an analysis that demonstrate that for the medically necessary health 
care criteria described in paragraph A and for each nonquantitative treatment limitation 
identified in paragraph B. as written and in operation. the processes. strategies. 
evidentiary standards or other factors used in applying the medically necessary health 
care criteria and each nonguantitative treatment limitation to mental health and 
substance use disorder benefits within each classification of benefits are comparable 
to, and are applied no more stringently than, the processes. strategies. evidentiary 
standards or other factors used in applying the medically necessary health care criteria 
and each nonguantitative treatment limitation to medical and surgical benefits within 
the corresponding classification of benefits. At a minimum. the results of the analysis 
must: 
(1) Identify the factors used to determine that a nonquantitative treatment limitation 
applies to a benefit, including factors that were considered but rejected; 
(2) Identify and define the specific evidentiary standards used to define the factors 
and any other evidence relied upon in designing each nonquantitative treatment 
limitation; 
(3) Identify and describe the comparative analyses. including the results of the 
analyses. used to determine that the processes and strategies used to design each 
nonquantitative treatment limitation. as written. for mental health and substance 
use disorder benefits are comparable to, and are applied no more stringently than, 
the processes and strategies used to design each nonquantitative treatment 
limitation, as written, for medical and surgical benefits; 
(4) Identify and describe the comparative analyses, including the results of the 
analyses, used to determine that the processes and strategies used to apply each 
nonquantitative treatment limitation, in operation, for mental health and substance 
use disorder benefits are comparable to, and applied no more stringently than, the 
processes and strategies used to apply each nonquantitative treatment limitation, in 
operation, for medical and surgical benefits; and 
(5) Disclose the specific findings and conclusions reached by the insurer that the 
results of the analyses in this paragraph indicate that the carrier is in compliance 
with this section and the federal Paul Wellstone and Pete Domenici Mental Health 
Parity and Addiction Equity Act of 2008 and its implementing and related 
regulations. including 45 Code of Federal Regulations, Sections 146 .13 6, 14 7 .13 6, 
147.160 and 156.115(a)(3). 
Information submitted by a carrier to the superintendent pursuant to this subsection is 
public information in accordance with section 216, except for information that a carrier 
requests be designated as confidential and the superintendent has determined is proprietary 
information. 
For the purposes of this subsection. "proprietary information" means 
information that is a trade secret or business or financial info1mation the disclosure of 
which would impair the competitive position of a carrier or that would result in significant 
detriment to a carrier if the information were made available to the public. 
5. Repeal. This section is repealed April 30, 2028. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "4" to H.P. 1355, L.D. 1822 
Sec. 5. 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 Market Conduct Examiner position and related 
All Other costs to evaluate consumer or provider complaints concerning mental health and 
substance use disorder coverage for federal parity violations, to facilitate new annual 
mental health and substance use disorder parity reporting requirements from insurers and 
to conduct market conduct examinations of carriers for compliance with federal parity law. 
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 
$102,269 
$10,472 
$112,741 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill. 
With respect to individual and small group health plans with an effective date on or 
after January 1, 2023, the amendment requires that, following the first visit provided 
without cost sharing, the copayment amount for a behavioral health office visit not be 
greater than the copayment amount for a primary care office visit and that any copayments 
for a primary care office visit and a behavioral health office visit count toward the 
deductible. 
With respect to a group health plan other than a small group health plan with an 
effective date on or after January 1, 2023, the amendment requires that coverage be 
provided without cost sharing for the first primary care office visit and first behavioral 
health office visit in each plan year and that, following the first visit, the copayment amount 
for a behavioral health office visit not be greater than the copayment amount for a primary 
care office visit. 
The amendment also requires carriers to demonstrate compliance with federal mental 
health parity laws and directs the Superintendent of Insurance to take certain actions, 
including examination and reporting requirements, related to enforcement of mental health 
parity laws. These requirements are repealed .on April 30, 2028. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/29/22 ,?-:Pae 
LD 1822 
LR2333(02) 
An Act To Improve Access to Behavioral Health Services by Prohibiting Cost Sharing by Insurers 
Fiscal Note for Bill as Amended by Committee Amendment'~' ( !{- 1; o) 
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 
FY2022-23 
$0 
$112,741 
Projections 
FY2023-24 
$115,112 
Projections 
FY2024-25 
$121,7'"' 
The bill provides an allocation of Other Special Revenue Funds of $112,741 in fiscal year 2022-23 to the Bureau of 
Insurance in the Department of Professional and Financial Regulation for one Senior Market Conduct Examiner 
position and related All Other costs to evaluate consumer or provider complaints concerning mental health and 
s:ubstance abuse disorder coverage for federal parity violations, to facilitate new annual mental health and substance 
abuse disorder parity reporting requirements from insurers and to conduct market conduct examinations of carriers for 
compliance with federal parity law. Additional costs to the State Employee Health Plan are expected to be minor and 
can be absorbed within existing budgeted resources.