An Act to Provide for Consistent Billing Practices by Health Care Providers
Maine Legislature, Session 131, LD 1533
Committee Amendment CA_A_H752 (House)
Amends: 24 MRSA §2332-E, 24-A MRSA §1912, 24-A MRSA §2680, 24-A MRSA §2753, 24-A MRSA §2823-B, 24-A MRSA §4235

COMMITTEE AMENDMENT "/1 » to H.P. 988, L,D, 1 533, "An Act to Provide for
Consistent Billing Practices by Health Care Providers"
Amend the bill by striking out everything after the enacting clause and inserting the
following;
'See. 1. 24 MRSA §2332-E, as amended by PL 2003,c,218,§1 and c,469, Ft, D,
§1 and affected by §9, is further amended to read:
§2332-E. Standardized claim forms
All nonprofit hospital or medical service organizations and nonprofit health care plans
providing payment or reimbursement for diagnosis or treatment of a condition or a
complaint by a licensed health care practitioner must accept the current standardized claim
form for professional services approved by the Federal Government and submitted
electronically, All nonprofit hospital or medical service organizations and nonprofit health
care plans providing payment or reimbursement for diagnosis or treatment of a condition
or a complaint by a licensed hospital must accept the current standardized claim form for
professional or facility services, as applicable, approved by the Federal Government and
submitted electronically, and any claims for facility services must identify the physical
location, including hospital off-campus locations, where services are provided, A nonprofit
hospital or medical service organization or nonprofit health care plan may not be required
to accept a claim submitted on a form other than the applicable form specified in this section
and may not be required to accept a claim that is not submitted electronically, except from
a health care practitioner who is exempt pursuant to section 2985,
30' Sec. 2. 24-A MRSA §1912, as amended by PL 2005, c. 97, § 1., is further amended
to read;
§1912. Standardized claim forms
All administrators who administer claims and who provide payment or reimbursement
for diagnosis or treatment of a condition or a complaint by a licensed health care
. practitioner must accept the current standardized claim form for professional services
COMMITTEE AMENDMENT
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COMMITTEE AMENDMENT " /T" to H.P. 988, L.D, 1533
approved by the Federal Government and submitted electronically, All administrators who
administer claims and who provide payment or reimbursement for diagnosis or treatment
of a condition or a complaint by a licensed hospital must accept the current standardized
claim form for professional or facility services, as applicable, approved by the Federal
Government and submitted electronically. and any claims for facility services must identify
the physical location, including hospital off-campus locations, where services are provided,
An administrator may not be required to accept a claim submitted on a form other than the
applicable form specified in this section and may not be required to accept a claim that is
not submitted electronically, except from a health care practitioner who is exempt pursuant
to Title 24, section 2985. All services provided by a health care practitioner in an office
setting must be submitted on the standardized federal form used by non institutional
providers and suppliers. Services in a nonoffice setting may be billed as negotiated
between the administrator and health care practitioner, For purposes of this section, "office
setting" means a location where the health care practitioner routinely provides health
examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether
or not the office is physically located within a facility,
Sec. 3. 24-A MRSA §2680, as amended by PL 2003,c.218,§5 and c, 469, Pt. D,
§5 and affected by §9, is further amended to read:
§2680. Standardized claim form
Administrators providing payment or reimbursement for diagnosis or treatment of a
condition or a complaint by a licensed health care practitioner or licensed hospital shall
accept the current standardized claim form for professional or facility services, as
applicable, approved by the Federal Government and submitted electronically, and any
claims for facility services must identify the physical location, including hospital off-
campus locations, where services are provided. An administrator may not be required to
accept a claim submitted on a form other than the applicable form specified in this section
and may not be required to accept a claim that is not submitted electronically, except from
a health care practitioner who is exempt pursuant to Title 24, section 2985.
Sec. 4. 24-A MRSA §2753, as amended by PL 2005, c, 97,§2, is further amended
to read;
§2753. Standardized claim forms
All insurers providing individual medical expense insurance on an expense-incurred
basis providing payment or reimbursement for diagnosis or treatment of a condition or a
complaint by a health care practitioner must accept the current standardized claim form for
professional services approved by the Federal Government and submitted electronically.
All insurers providing individual medical expense insurance on an expense-incurred basis
providing payment or reimbursement for diagnosis or treatment of a condition or a
complaint by a licensed hospital must accept the current standardized claim form for
professional or facility services, as applicable, approved by the Federal Government and
submitted electronically, and any claims for facility services must identif/ the physical
location, including hospital off-campus locations. where services are provided. An insurer
may not be required to accept a claim submitted on a form other than the applicable form
specified in this section and may not be required to accept a claim that is not submitted
electronically, except from a health care practitioner who is exempt pursuant to Title 24,
section 2985. All services provided by a health care practitioner in an office setting must
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COMMITTEE AMENDMENT
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COMMITTEE AMENDMENT " H" to H,P, 988, L.D. 1533
be submitted on the standardized federal form used by noninstitutional providers and
suppliers, Services in a nonoffice setting may be billed as negotiated between the insurer
and health care practitioner, For purposes of this section, "office setting means a location
where the health care practitioner routinely provides health examinations, diagnosis and
treatment of illness or injuiy on an ambulatory basis whether or not the office is physically
located within a facility,
Sec. 5. 24-A MRSA §2823-B, as amended by PL 2005,c,97,§3, is further amended
to read:
§2823-B. Standardized claim forms
All insurers providing group medical expense insurance on an expense-incurred basis
providing payment or reimbursement for diagnosis or treatment of a condition or a
complaint by a licensed health care practitioner must accept the current standardized claim
form for professional services approved by the Federal Government and submitted
electronically, All insurers providing group medical' expense insurance on an expense-
incurred basis providing payment or reimbursement for diagnosis or treatment of a
condition or a complaint by a licensed hospital must accept the current standardized claim
form for professional or facility services, as applicable, approved by the Federal
Government and submitted electronically, and any claims for facility services must identify
the physical location, including hospital off-campus locations, where services are provided,
An insurer may not be required to accept a claim submitted on a form other than the
applicable form specified in this section and may not be required to accept a claim that is
not submitted electronically, except from a health care practitioner who is exempt pursuant
to Title 24, section 2985, All services provided by a health care practitioner in an office
setting must be submitted on the standardized federal form used by noninstitutional
providers and suppliers. Services in a nonoffice setting may be billed as negotiated
between the insurer and health care practitioner. For purposes of this section, "office
setting" means a location where the health care practitioner routinely provides health
examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether
or not the office is physically located within a facility,
Sec. 6. 24-A MRSA §4235, as amended by PL 2005, c,97,§4, is further amended
to read;
§4235. Standardized claim forms
All health maintenance organizations providing payment or reimbursement for
diagnosis or treatment of a condition or a complaint by a licensed health care practitioner
must accept the current standardized claim form for professional services approved by the
Federal Government and submitted electronically, All health maintenance organizations
providing payment or reimbursement for diagnosis or treatment of a condition or a
complaint by a licensed hospital must accept the current standardized claim form for
professional or facility services, as applicable, approved by the Federal Government and
submitted electronically, and any claims for facility services must identify the physical
location, including hospital off-campus locations, where services are provided. A health
maintenance organization may not be required to accept a claim submitted on a form other
than the applicable form specified in this section and may not be required to accept a claim
that is not submitted electronically, except from a health care practitioner who is exempt
pursuant to Title 24, section 2985. All services provided by a health care practitioner in an
COMMITTEE AMENDMENT
;/t " to H,P.
COMMITTEE AMENDMENT "/f " to H,P. 988, L.D. 1533
office setting must be submitted on the standardized federal form used by noninstitutional
providers and suppliers. Services in a nonoffice setting may be billed as negotiated
between the health maintenance organization and health care practitioner. For purposes of
this section, "office setting" means a location where the health care practitioner routinely
provides health examinations, diagnosis and treatment of illness or injury on an ambulatory
basis whether or not the office is physically located within a facility,'
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section
number to read consecutively,
SUMMARY
This amendment replaces the bill. The amendment requires that claims for facility
services that are submitted for payment or reimbursement to nonprofit hospital or medical
service organizations, nonprofit health care plans, administrators, insurers or health
maintenance organizations must identify the physical location where services are rendered,
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COMMITTEE AMENDMENT