An Act to Advance the National HIV/AIDS Strategy in Maine by Broadening HIV Testing
Maine Legislature, Session 131, LD 1736
Committee: Health Coverage, Insurance and Financial Services
Sponsors: OSHER, BALDACCI, CRAVEN, DHALAC, GEIGER, JAVNER, MILLIKEN, MOONEN, MOORE
Amends: 5 MRSA §19203-G, 24-A MRSA §4317-D

Legislative Document
No. 1736
H.P. 1115
House of Representatives, April 20, 2023
An Act to Advance the National HIV/AIDS Strategy in Maine by 
Broadening HIV Testing
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative OSHER of Orono.
Cosponsored by Senator BALDACCI of Penobscot and
Representatives: CRAVEN of Lewiston, DHALAC of South Portland, GEIGER of Rockland, 
JAVNER of Chester, MILLIKEN of Blue Hill, MOONEN of Portland, Senator: MOORE of 
Washington.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA §19203-G is enacted to read:
§19203-G.  HIV testing required 
1.  Testing for persons 13 years of age or older.  Subject to the consent and procedure 
requirements of section 19203-A, subsection 1, an individual 13 years of age or older who 
is receiving health care services in a hospital or urgent care facility or from a primary care 
provider in an outpatient setting must be offered an HIV test if the individual has not been 
under the regular care of a primary care provider unless the individual is being treated for 
a life-threatening emergency. As used in this subsection, "primary care provider" means an 
osteopathic or allopathic physician or physician assistant or nurse practitioner licensed 
under Title 32 who provides health care in a primary care setting.
2.  Testing in conjunction with testing for possible sexually transmitted diseases 
and infections.  Subject to the consent and procedure requirements of section 19203-A, 
subsection 1, a health care provider shall include an HIV test in the standard set of medical 
tests performed on an individual with a possible sexually transmitted disease or infection. 
If an individual declines to be tested for HIV pursuant to this subsection, the health care 
provider shall document the individual’s decision in the individual’s medical record.
Sec. 2.  24-A MRSA §4317-D, as enacted by PL 2021, c. 265, §4, is amended to 
read:
§4317-D.  Coverage of HIV prevention drugs and HIV testing
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "CDC guidelines" means guidelines related to the nonoccupational exposure to 
potential HIV infection, or any subsequent guidelines, published by the federal 
Department of Health and Human Services, Centers for Disease Control and 
Prevention.
B.  "HIV prevention drug" means a preexposure prophylaxis drug, post-exposure 
prophylaxis drug or other drug approved for the prevention of HIV infection by the 
federal Food and Drug Administration.
B-1.  "HIV test" has the same meaning as in Title 5, section 19201, subsection 4-A.
C.  "Post-exposure prophylaxis drug" means a drug or drug combination that meets the 
clinical eligibility recommendations provided in CDC guidelines following potential 
exposure to HIV infection.
D.  "Preexposure prophylaxis drug" means a drug or drug combination that meets the 
clinical eligibility recommendations provided in CDC guidelines to prevent HIV 
infection.
2.  Coverage required for HIV prevention drugs.  A carrier offering a health plan in 
this State shall provide coverage for an HIV prevention drug that has been prescribed by a 
provider.  Coverage under this section is subject to the following.
A.  If the federal Food and Drug Administration has approved one or more HIV 
prevention drugs that use the same method of administration, a carrier is not required 
to cover all approved drugs as long as the carrier covers at least one approved drug for 
each method of administration with no out-of-pocket cost.
B.  A carrier is not required to cover any preexposure prophylaxis drug or post-
exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy 
provider unless the enrollee's health plan provides an out-of-network pharmacy benefit.
C.  A carrier may not prohibit, or permit a pharmacy benefits manager to prohibit, a 
pharmacy provider from dispensing or administering any HIV prevention drugs.
3.  Limits on prior authorization and step therapy requirements.  Notwithstanding 
any requirements in section 4304 or 4320‑N to the contrary, a carrier may not subject any 
HIV prevention drug to any prior authorization or step therapy requirement except as 
provided in this subsection.  If the federal Food and Drug Administration has approved one 
or more methods of administering HIV prevention drugs, a carrier is not required to cover 
all of the approved drugs without prior authorization or step therapy requirements as long 
as the carrier covers at least one approved drug for each method of administration without 
prior authorization or step therapy requirements. If prior authorization or step therapy 
requirements are met for a particular enrollee with regard to a particular HIV prevention 
drug, the carrier is required to cover that drug with no out-of-pocket cost to the enrollee.
4.  Coverage for laboratory testing related to HIV prevention drugs.  A carrier 
offering a health plan in this State shall provide coverage with no out-of-pocket cost for 
laboratory testing recommended by a provider related to the ongoing monitoring of an 
enrollee who is taking an HIV prevention drug covered by this section.
5.  Coverage for annual HIV test and testing in conjunction with testing for 
sexually transmitted diseases and infections.  A carrier offering a health plan in this State 
shall provide coverage with no out-of-pocket cost for:
A.  An annual HIV test for an enrollee 13 years of age or older; and
B.  An HIV test done in conjunction with tests performed on an enrollee with a possible 
sexually transmitted disease or infection as required by Title 5, section 19203-G, 
subsection 2.
Sec. 3.  Application. That section of this Act that amends the Maine Revised 
Statutes, Title 24-A, section 4317-D applies to all policies, contracts and certificates 
executed, delivered, issued for delivery, continued or renewed in this State on or after 
January 1, 2024.  For purposes of this Act, all contracts are deemed to be renewed no later 
than the next yearly anniversary of the contract date.
SUMMARY
This bill makes the following changes to broaden HIV testing in the State.
1.  It requires an individual 13 years of age or older who is receiving medical services 
in a hospital or in an urgent care facility or from a primary care provider in an outpatient 
office setting to be offered an HIV test if the individual has not been under regular care 
from a primary care provider unless that individual is being treated for a life-threatening 
emergency.
2.  It requires a health care provider to include an HIV test in the standard set of medical 
tests performed on an individual with a possible sexually transmitted disease or infection.
3.  It requires health insurance carriers to provide coverage for annual HIV testing for 
all individuals 13 years of age or older in health insurance policies and contracts beginning 
January 1, 2024.