An Act Concerning Prior Authorizations for Health Care Provider Services
Maine Legislature, Session 131, LD 0796
Committee Amendment CA_B_H955 (House)
Amends: 24-A MRSA §4302

COMMITTEE AMENDMENT,£" to H.P. 485, L.D. 796, "An Act Concerning 
Prior Authorizations for Health Care Provider Services" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA §4302, sub-§2, as amended by PL 2007, c. 199, Pt. B, §3, is 
further amended to read: 
2. 
Plan eamplaiat; complaints and adverse decisions; pt'iaf' aath0f'iii!iati0a 
statistics. A carrier shall provide annually to the superintendent information for each 
health plan that it offers or renews on plan complaints; and adverse decisions afl:d pFiof 
autho£i2aatioa statistics. This statistical information must contain, at a minimum: 
A. The ratio of the number of complaints received by the plan to the total number of 
enrollees, reported by type of complaint and category of enrollee; 
B. The ratio of the number of adverse decisions issued by the plan to the number of 
complaints received, reported by category; 
C. The fatio oftl¼e HUmbef of pFiof autl¼ofi2aatioas deaied by the plaa to the HUmbef of 
pfiof aathod2aatioas feqitestea, feported by oategozy; 
D. The ratio of the number of successful enrollee appeals overturning the original 
denial to the total number of appeals filed; 
E. The percentage of disenrollments by enrollees and providers from the health plan 
within the previous 12 months and the reasons for the disenrollments. With respect to 
enrollees, the information provided in this paragraph must differentiate between 
voluntary and involuntary disenrollments; and 
F. Enrollee satisfaction statistics, including provider-to-enrollee ratio by geographic 
region and medical specialty and a rep01t on what actions, if any, the carrier has taken 
to improve complaint handling and eliminate the causes of valid complaints. 
Sec. 2. 24-A MRSA §4302, sub-§2-A is enacted to read: 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT ".{5'' to H.P. 485, L.D. 796 
2-A. Reporting of information related to prior authorization. In addition to the 
information required to be provided under subsection 2, a carrier shall report to the 
superintendent the following information consistent with federal requirements for reporting 
of metrics related to prior authorization determinations for the prior calendar year, 
excluding data on prescription drugs: 
A. A list of all items and services that require prior authorization: 
B. The number and percentage of standard prior authorization requests that were 
approved, aggregated for all items and services; 
C. The number and percentage of standard prior authorization requests that were 
denied, aggregated for all items and services: 
D. The number and percentage of standard prior authorization requests that were 
approved after appeal. aggregated for all items and services; 
E. The number and percentage of prior authorization requests for which the time frame 
for review was extended. and the request was approved, aggregated for all items and 
services; 
F. The number and percentage of expedited prior authorization requests that were 
approved, aggregated for all items and services: 
G. The number and percentage of expedited prior authorization requests that were 
denied, aggregated for all items and services: 
H. The average and median time that elapsed between the submission of a request and 
a determination by the carrier. for standard prior authorizations. aggregated for all 
items and services: and 
I. The average and median time that elapsed between the submission of a request and 
a decision by the carrier for expedited prior authorizations, aggregated for all items and 
services. 
Sec. 3. 24-A MRSA §4302, sub-§2-B is enacted to read: 
2-B. Data reporting; utilization review data. Beginning April 1, 2026 and annually 
thereafter, the superintendent shall collect the information required under subsections 2 and 
2-A, together with the utilization review information collected pursuant to section 2749. 
Sec. 4. 
Stakeholder group on prior authorization requirements. 
The 
Department of Professional and Financial Regulation, Bureau of Insurance shall convene 
a stakeholder group that includes representatives of physicians, hospitals, consumers, 
employers subject to state regulation, pharmacy benefit managers and health insurance 
carriers to consider the impact of prior authorization requirements on providers, enrollees 
and health care costs and outcomes. The Bureau of Insurance shall submit a report 
summarizing its findings no later than Janua1y 15, 2025 to the joint standing committee of 
the Legislature having jurisdiction over health coverage, insurance and financial services 
matters. The committee may report out a bill related to findings in the report to the 132nd 
Legislature in 2025 .
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
COMMITTEE AMENDMENT 
ROS 
........, 
COMMfITEE AMENDMENT~ "to H.P. 485, L.D. 796 
SUMMARY 
This amendment, which is the minority report of the committee, replaces the bill, which 
is a concept draft. The amendment requires carriers to report to the Department of 
Professional and Financial Regulation, Bureau of Insurance certain information related to 
prior authorization determinations consistent with federal requirements beginning April 1, 
2026 and annually thereafter. 
The amendment also requires the Bureau of Insurance to convene a stakeholder group 
to consider the impact of prior authorization requirements on providers, enrollees and 
health care costs and report back to the joint standing committee of the Legislature having 
jurisdiction over health coverage, insurance and financial services by January 15, 2025. 
The committee may report out a bill related to any findings in the report to the 132nd 
Legislature in 2025. 
FISCAL NOTE REQUffiED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/15/24 :b.?ae:.. 
LD796 
LR1786(03) 
An Act Concerning Prior Authorizations for Health Care Provider Services 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment '£ (}(-955) 
Committee: Health Coverage, Insurance and Financial Services 
1/ 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Ally additional costs to the Department of Professional and Financial Regulation from the provisions of this bill are 
expected to be minor and can be absorbed within existing budgeted resources.